M. L. Baker, J. J. Wang, G. Liew, P. J. Hand, D. A. De Silva, R. I. Lindley, P. Mitchell, M. C. Wong, E. Rochtchina, T. Y. Wong, J. M. Wardlaw, G. J. Hankey, Multi-Ctr Retinal Stroke Study Grp



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Wang, JJ Univ Sydney C24, Westmead Hosp, Westmead Millennium Inst, Ctr Vis Res, Sydney, NSW 2145, Australia Univ Melbourne, Ctr Eye Res Australia, Melbourne, Vic, Australia Univ Sydney, Ctr Vis Res, Westmead Millennium Inst, Sydney, NSW 2006, Australia Univ Melbourne, Royal Melbourne Hosp, Dept Neurol, Melbourne, Vic 3050, Australia Singapore Gen Hosp Campus, Natl Inst Neurosci, Singapore, Singapore Univ Sydney, Westmead Hosp, Sydney Med Sch Western, Discipline Med, Sydney, NSW 2006, Australia Natl Med Res Council, Singapore, Singapore Natl Univ Singapore, Singapore Eye Res Inst, Singapore 0511, Singapore Univ Edinburgh, Western Gen Hosp, Dept Clin Neurosci, SINAPSE Collaborat, Edinburgh, Midlothian, Scotland Univ Western Australia, Royal Perth Hosp, Nedlands, WA 6009, Australia

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Background and Purpose-The relationship of cortical and subcortical cerebral atrophy to cerebral microvascular disease is unclear. We aimed to assess the associations of retinal vascular signs with cortical and subcortical atrophy in patients with acute stroke.
Methods-In the Multi-Centre Retinal Stroke Study, 1360 patients with acute stroke admitted to 2 Australian and 1 Singaporean tertiary hospital during 2005 to 2007 underwent neuroimaging and retinal photography. Cortical and subcortical cerebral atrophy were graded based on standard CT scans. A masked assessment of retinal photographs identified focal retinal vascular signs, including retinopathy and retinal arteriolar wall signs (ie, focal arteriolar narrowing, arteriovenous nicking, arteriolar wall light reflex) and measured quantitative signs (retinal arteriolar and venular caliber).
Results-After adjusting for age, gender, study site, hypertension, hypercholesterolemia, diabetes, and smoking status, none of the retinal vascular signs assessed were associated with cortical atrophy, whereas retinopathy (OR, 1.9; CI, 1.2 to 3.0) and enhanced arteriolar light reflex (OR, 2.0; CI, 1.2 to 3.2) were significantly associated with subcortical atrophy.
Conclusion-Our finding that certain retinal vascular signs are associated with subcortical but not cortical atrophy, suggests a differential pathophysiology between these 2 cerebral atrophy subtypes and a potential role for small vessel disease underlying subcortical cerebral atrophy. (Stroke. 2010;41:2143-2150.)