RESEARCH HIGHLIGHTS STROKE Retinal small-vessel changes and lacunar stroke A large study of patients with acute stroke The cross-sectional study recruited a 2.32-fold increased chance of having suggests that the substantial proportion 1,321 patients with acute ischemic stroke enhanced light reflex of the arteriolar who have acute lacunar stroke could presenting at two centres in Australia and wall, and a 1.96-fold increased chance of have an underlying non-atherothrombic, one in Singapore. In addition to standard having arteriovenous nipping. occlusive, small-vessel disease rather than clinical assessment, each patient had either Lindley says that the study has two a thrombotic disorder. This could explain a CT scan or an MRI scan of the brain, and major implications: “firstly, we hope to why antiplatelet treatments have proved retinal photographs were taken of each eye trigger a paradigm shift on what could ineffective in large stroke-prevention and then graded for retinal microvascular be causing lacunar stroke and make trials. “In the MATCH trial published in signs. An accurate diagnosis of lacunar researchers more aware of the other 2004, for example, 53% of patients had stroke was made in 410 patients by means potential non-thrombotic mechanisms acute lacunar stroke; it is, therefore, no of a modified version of the Treatment of that have been suggested in the literature. surprise that antithrombotic therapy Acute Stroke Trial criteria or the Oxford Secondly, we hope to increase the research failed to have an impact,” notes lead Community Stroke Project criteria, and activity in this neglected form of stroke, author Richard Lindley, of the University according to the findings on MRI scans. which affects millions of people each of Sydney, Australia. year”. Since clinical management and Investigating the underlying cause potential interventions for lacunar stroke of lacunar stroke is difficult because of ...we hope to trigger a have traditionally been based on the the low death rate, which limits autopsy paradigm shift on what could be assumption of underlying thrombotic findings, and because noninvasive brain ‘‘ small-vessel disease, “our study imaging techniques such as standard MRI causing lacunar stroke... emphasizes the need for distinct and and CT scans have insufficient resolution possibly new approaches to tackle to examine small cerebral arteries in “Patients with acute lacunar’’ stroke this important debilitating disease,” detail. Lindley and colleagues designed were more likely to have a range of retinal concludes Lindley. their study to try to establish whether microvascular signs than are patients with Kathryn Senior changes in the retinal microvasculature non-lacunar stroke,” explains Lindley. For could be used to monitor cerebral example, people with acute lacunar stroke Original article Lindley, R. I. et al. Retinal microvasculature microvascular disease and so act as an had a 3.55-fold increased chance in acute lacunar stroke: a cross-sectional study. Lancet Neurol. 8, 628–634 (2009). indicator of lacunar stroke. of having focal arteriolar narrowing, NATURE REVIEWS | NEUROLOGY VOLUME 5 | AUGUST 2009 | 406 © 2009 Macmillan Publishers Limited. All rights reserved.