One in every 10,000 patients who attend our hospital's eye emergency department has a stroke of the retina, which presents with a sudden loss of vision in one eye. These are the incidences described in the scientific literature, although doctors treating clinical cases see higher numbers. Stroke is a rare disease, but the lack of awareness on the part of the population worries healthcare workers because, as with stroke, if it is detected and treated promptly, a person has a better chance of regaining his or her vision. Because it is a painless disease, many patients do not immediately go to the emergency room. Wrong because in addition to causing loss of vision in the eye, it can mean a heart attack or stroke.
Stroke consists of central retinal artery occlusion. To the eye, it resembles a stroke. It is not a new disease, but in recent years more emphasis has been placed on it. The German Trias i Pujol Hospital (Can Ruti), in Badalona, has developed a protocol pioneered in Catalonia and Spain (called the Retinal Stroke Code) that allows early detection and treatment of these conditions to prevent vision loss. Since 2018, the year it was launched, the protocol has so far treated about 120 cases of retinal clots.
“A stroke is a blockage of the ophthalmic artery. A clot occurs in the carotid artery, which goes to the eye instead of reaching the brain,” explains Susana Ruiz Bilbao, retina specialist at the Ophthalmology Service of Can Roti. What are the symptoms? Ruiz explains: “Sudden loss of vision in one eye. The patient goes from seeing to not seeing in one eye, and does not feel any pain. When he looks in the mirror, he does not see external signs either.” -Bilbao.
This is why many people do not realize this and decide, for example, to go to sleep thinking that this will happen to them. On the same day that EL PERIÓDICO prepared this report, Can Ruti's Retinal Stroke Code cared for a woman who had lost sight in one eye for three weeks (since King's Day). Likewise, a man who had symptoms for 24 hours. Both cases were retinal strokes.
“Just like a stroke, a stroke must also be treated quickly. If blood does not reach the eye for a few hours, vision can be lost. Action should be taken between the next four and six hours. But better in an hour than in four,” points out Dr. Ruiz Bilbao.
Next to him, neurologist Natalia Pérez de la Osa, coordinator of the Can Ruti Stroke Unit, explains that the “risk factors” in this disease are “the same” as in any other cardiovascular disease. “The populations most at risk are the elderly, people with cardiovascular risks, high blood pressure, diabetes, or smoking,” Perez de la Osa points out. In addition, arrhythmia is also a risk factor for retinal stroke.
Doctors insist the public must “realize that this disease exists and that ‘you have to run.’” With a blood clot in the heart or brain you can die. “Not with a retinal stroke, but you can go blind,” warns Ruiz Bilbao. Kan Ruti sees about 20 cases a year, so he believes the infection rate is “much higher” than the scientific literature describes. “Because we are aware of it, and we look for it immediately,” adds this retina scientist.
The Can Roti protocol is considered a pioneer in Catalonia and the rest of Spain, although it aspires to spread to other hospitals in the region. What does the stroke symbol consist of? “A patient with these symptoms should go to the hospital as soon as possible. If he goes to the health center, they should send him by ambulance to the hospital. We have already done the triage so they don’t have to wait, they go straight to the eye doctor and he He communicates with the neurologist,” explains Dr. Ruiz Bilbao.
The difference between a stroke code and a retinal stroke code is that the former is activated from the Emergency Medical System (EMS), while the latter is activated from the hospital itself. “We treat patients with retinal stroke in the same unit as the rest of the stroke patients,” explains Alejandro Bustamante, a doctor at the Can Roti Stroke Unit.
Some CT scans
“We monitor their vital signs and blood samples and do a neurological examination,” Bustamante adds. “We also do a CT scan of the skull because sometimes a stroke happens simultaneously. And another CT scan of their blood vessels to see the condition of their general circulation.” If the patient is a candidate, the necessary treatments are applied to dissolve the clot and get blood back to the retina. According to this doctor, if retinal stroke is detected in time, vision can improve in one out of every three patients.
However, sometimes patients arrive too late and the only thing that can be done for them is to prevent them from experiencing further complications. “Even ophthalmologists don't always give it the importance it has,” says Dr. Ruiz Bilbao.
Although patients with retinal strokes have a “very high risk,” according to Pérez de la Osa, of having a stroke, as well as other cardiovascular problems, in the following weeks. “This happens because a stroke is a symptom of circulatory problems. That is why the goal here is not only to treat it, but also to study the source of this clot and prevent circulatory diseases in the future,” explains this neurologist.
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