Eur J Neurol. 2021 Aug 19. doi: 10.1111/ene.15074. Online ahead of print.
ABSTRACT
PURPOSE: To validate a clinical score of vascular origin in patients with acute transient visual disturbances (TVD) without diplopia.
METHODS: We conducted a prospective study in an ophthalmology emergency department and a TIA clinic. Patients underwent clinical evaluation including a tailored questionnaire, brain, vascular, and ophthalmic investigations, and 3-month follow-up. TVD were classified according to vascular or nonvascular origin by three independent experts based on all clinical, cerebrovascular, and ophthalmologic investigations, but blind to the questionnaire results. A clinical score was derived based on clinical variables independently associated with a vascular origin, and was externally validated in an independent cohort.
RESULTS: An ischemic origin of TVD was found in 45% (67/149) of patients in the derivation cohort. Age and six questions were independently associated with an ischemic origin. A nine-point score (≥70 years=2; monocular visual loss=2; black or white vision=1; single episode=1; lack of headache=2; diffuse, constricted, altitudinal or lateralized visual loss pattern on drawings=1) showed good discriminative power in identifying ischemic origin (c-statistic 0.82) and was replicated in the validation cohort (n=130; 25% of ischemic origin; c-statistic 0.75). With a score ≥4, sensitivity was 85% (95% confidence interval 68-95) and specificity was 52% (95% confidence interval 41-62). In both cohorts, ophthalmic evaluation found a vascular cause in 4% and was noncontributive in 85%. After 3 months, no patients had a stroke, TIA, or retinal infarct.
CONCLUSION: Our score may assist in predicting a nonvascular origin of TVD. Ophthalmic evaluation, when not readily available, should not delay the neurovascular evaluation.
PMID:34411384 | DOI:10.1111/ene.15074
