Higher risk of poor functional outcome in the presence of visual deficits post-stroke
Reviewed by Lauren Hepworth

The authors present a retrospective case review with the aim of reporting the disability outcomes of individuals 90-days post stroke with and without visual deficits. The Houston Methodist Hospital Outcomes-based Prospective Endpoints in Stroke (HOPES) Registry was used as the data source. Medical history, modified Rankin Scale (mRS) at 90 days and thrombolysis decision were collected. A total of 3275 acute ischemic strokes were identified in the registry, of which 1074 had abnormal National Institutes of Health Stroke Scale (NIHSS) scores for gaze palsy, visual fields or inattention. From those records identified to have visual deficits, 155 medical records from 2020-2021 were reviewed, alongside 155 medical records from the same time period with normal scores on the NIHSS visual subscores. The location of the stroke, admission and discharge NIHSS detailing visual subscores, thrombolysis / thrombectomy treatment and associated post-treatment NIHSS and last known documentation of the patient being well through to needle time were collected. The group with visual deficits were significantly older with a significantly higher prevalence of atrial fibrillation. The NIHSS was significantly higher (higher stroke severity) in the visual deficits group at admission, discharge and post-thrombolysis. The multivariate logistic model with adjustments made for demographics and co-morbidities identified individuals with visual deficits are four times more likely to have a poor functional outcome at 90 days. There are several limitations to this study including the retrospective methodology, small sample size and reliance on the NIHSS to identify visual deficits. Further research is required to assess functional outcomes for all post-stroke visual deficits, with sub-group analysis of visual field loss and visual inattention due to the latter already being associated with poor functional outcomes.

Long-term disability outcomes for patients with ischemic stroke presenting with visual deficits.
Johnson N, Nisar T, Criswell A, et al.
JOURNAL OF NEURO-OPHTHALMOLOGY
2022;42:518-23.