Ocular Fundus Abnormalities for Acute Risk Stratification in TIA and Minor Stroke

描述（由申请人提供）：短暂性脑缺血发作（TIA）和轻微中风每年影响数十万美国人。高达20%的TIA和轻微卒中患者在90天内会发生新的（通常是致残性的）卒中或心血管事件，其中大多数新事件发生在初始事件后的最初几小时和几天内。重要的研究一直集中在创建经过验证的，易于使用的工具，为临床医生提供准确的估计TIA和轻微卒中后的卒中风险，但仍有很大的改进空间。眼科学有一个重要的机会来帮助解决这个难题，因为眼底是中枢神经系统（CNS）及其相关微血管系统的一部分可以无创地直接可视化的唯一地方。基于我们的初步数据，我们假设眼底（视神经和视网膜）的急性视网膜病变和血管病变变化不仅是急性CNS组织损伤的生物标志物，而且提供了有关其他重要卒中风险因素（例如，高血压和糖尿病）。我们提出了一项前瞻性、观察性队列研究，以验证和复制我们在一项760名受试者的完全把握度研究中的早期结果。我们将使用非散瞳摄影术评估眼底异常，这种摄影术可以在不扩大瞳孔的情况下拍摄高质量的视神经和视网膜照片。我们的目的是（1）确定眼底异常是否是一个独立的预测因子，超过其他临床特征和神经影像学研究，短期（即，在90 天）临床结果（新发中风、心血管事件和死亡），以及（2）确定疑似TIA患者的眼底异常是否区分脑血管诊断患者与非脑血管诊断患者。我们将在三个埃默里大学附属医院的急诊科和中风服务中心开展该项目。我们的项目有可能将我们初步的流行病学研究结果转化为临床护理，并通过低成本、普遍可用但未充分利用的体格检查方面改善TIA和轻微卒中的评估，当通过非散瞳眼底摄影增强时，提供了改善的诊断能力，并在需要额外专业知识时提供了远程医疗咨询的潜力。

DESCRIPTION (provided by applicant): Transient ischemic attack (TIA) and minor strokes affect hundreds of thousands of Americans each year. Up to 20% of patients affected by TIA and minor stroke will have a new, often disabling, stroke or cardiovascular event within 90 days, with the majority of these new events occurring in the first few hours and days after the initial events. Significant research has been focused on creating validated, easy-to-use tools that provide clinicians with accurate estimates of stroke risk after TIA and minor stroke, but there is substantial room for improvement. Ophthalmology has an important opportunity to assist with this difficult problem because the ocular fundus is the only place where part of the central nervous system (CNS) and its associated microvasculature can be directly visualized non-invasively. Based on our preliminary data, we hypothesize that acute retinopathic and vasculopathic changes in the ocular fundus (optic nerve and retina) are not only biomarkers of acute CNS tissue injury, but provide severity information about other important stroke risk factors (e.g., hypertension and diabetes). We propose a prospective, observational cohort study to validate and replicate our early results in a fully-powered study of 760 subjects. We will assess ocular fundus abnormalities using non-mydriatic photography, which allows high quality photographs of the optic nerve and retina to be taken without dilation of the pupils. Our aims are (1) to determine whether abnormalities of the ocular fundus are an independent predictor, above and beyond that of other clinical features and neuroimaging studies, of short-term (i.e., within 90 days) clinical outcomes (new stroke, cardiovascular events, and death) in patients presenting with TIA and minor stroke, and (2) to determine whether abnormalities of the ocular fundus among patients with suspected TIA differentiate patients with cerebrovascular diagnoses vs. those with non- cerebrovascular diagnoses. We will conduct the project at three Emory University-affiliated hospital's emergency departments and stroke services. Our project has the potential to translate our preliminary epidemiological findings into clinical care and improve the evaluation of TIA and minor stroke with a low-cost, universally available, but underutilized, aspect of the physical examination that when augmented by non- mydriatic fundus photography provides improved diagnostic capabilities and the potential for telemedical consultation when additional expertise is required.