LUCUNAR INFARCTS AND WHITE-MATTER ATTENUATION - OPHTHALMOLOGIC AND MICROCIRCULATORY ASPECTS OF THE PATHOPHYSIOLOGY

Background and Purpose: By means of neurological and ophthalmologic ex aminations we considered whether there is a microcirculatory disorder not related to hypertension and diabetes in patients with lacunar infa rcts and whether there are microcirculatory differences in patients wi th lacunar infarcts compared with those with white matter attenuation. Methods: Eighty neurological patients with a lacunar infarct underwen t computed tomography and, based on the results, were prospectively as signed to subgroups as follows: (1) patients without changes; (2) pati ents with white matter attenuation but without lacunar infarcts; (3) p atients with lacunar infarcts alone; and (4) patients with both lacuna r infarcts and white matter attenuation. Clinical and ophthalmologic p arameters were monitored. The retinal microcirculation was studied by videofluorescence angiography. These neurological patients were compar ed with control ophthalmologic patients matched for age, sex, hyperten sive and diabetic ocular fundus changes, and smoking habits. Results: On average, the 80 patients with lacunar infarcts had a significantly (P=.0001) slower arteriovenous passage time (2.6+/-0.7 seconds) than t he ophthalmologic control subjects (1.6+/-0.6 seconds). Arteriovenous dye passage time through the retinal microcirculation was nearly norma l (2.2+/-0.8 seconds) in patients with white matter attenuation alone, but was significantly prolonged in patients with lacunar infarcts (2. 9+/-0.8 seconds, P=.00085) or both white matter attenuation and lacuna r infarcts (2.8+/-0.4 seconds, P=.008). Conclusions: Patients with lac unar infarcts are characterized by an additional disorder of retinal m icrocirculation independent of arterial hypertension and diabetes. Our data suggested that white matter attenuation and lacunar infarcts may be phenomena with only weak interdependence.