To evaluate, in a consecutive series of patients with isolated acute retinal ischemia, the proportion of patients with acute silent brain infarcts (SBI) on diffusion-weighted imaging (DWI) and to assess risk of recurrence within 3 months.
103 consecutive patients with isolated acute retinal ischemia (central retinal artery occlusion, branch retinal artery occlusion or transient monocular vision loss) were included between January 2015 and December 2016. They all had cerebral MRI including DWI as well as a standardized etiological workup and 3 months follow-up. The presence of DWI-positive cerebral lesions was recorded. Main clinical and radiological characteristics between DWI-positive and DWI-negative patients were compared.
Of the 103 patients (including 42 transient monocular vision loss), twenty (19.5%) had SBI on DWI, which were ipsilateral to the acute retinal ischemia in 30% and involved different and/or multiple vascular territories in 70%. of cases. Ipsilateral carotid stenosis and occlusion were respectively identified in 17 and 8 patients whereas cardioaortic embolism was found in 19 patients. Overall, patients with and without acute SBI were comparable. The topography of SBI was related to the aetiology of the acute retinal ischemia. At 3-months follow-up, 1 patient suffered from ischemic stroke and 5 had recurrent retinal ischemia.
Irrespective of the baseline characteristics of the patients, silent brain infarcts are present in about 20% of patients with isolated acute retinal ischemia and may be of interest in the aetiological workup. Overall risk of recurrence is low favoured by rapid aetiological workup and appropriate treatment.

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