From the Guidelines
Sudden blurry vision is a potential indication for stroke workup, particularly when it occurs alongside other neurological symptoms, and patients should seek immediate medical attention. This visual disturbance may signal a stroke affecting the visual pathways in the brain, especially in the occipital lobe or brainstem. According to the American Heart Association, central retinal artery occlusion (CRAO) is defined as an acute ischemic stroke, and its management should follow the guidelines for stroke treatment 1. The standard stroke workup typically includes a neurological examination, brain imaging (CT or MRI), carotid ultrasound, and blood tests to assess for stroke risk factors. Time is critical in stroke management, as treatments like tissue plasminogen activator (tPA) are most effective when administered within 3-4.5 hours of symptom onset. However, it's essential to note that sudden blurry vision can also result from other conditions such as migraine, retinal problems, or ocular emergencies, which is why prompt and thorough evaluation is necessary to determine the underlying cause and appropriate treatment. Some key points to consider in the management of acute retinal ischemia include:
- Urgent brain magnetic resonance imaging with diffusion-weighted imaging, vascular imaging, and clinical assessment to identify patients at highest risk for recurrent stroke 1
- Noninvasive imaging of the cervicocephalic vessels, such as MRA or CTA, or carotid ultrasound/transcranial Doppler, to evaluate the cause of the ischemia 1
- Echocardiography, at least transthoracic echocardiography, to identify potential cardiac sources of embolism 1
- Hospitalization for patients with transient ischemic attack (TIA), branch retinal artery occlusion (BRAO), or CRAO if they present within 72 hours of the event and have abnormal brain DWI-MRI or other high-risk features 1. Given the potential for sudden blurry vision to be a symptom of stroke, it is crucial to prioritize prompt evaluation and treatment to minimize morbidity, mortality, and improve quality of life.
From the Research
Sudden Blurry Vision and Stroke Workup
- Sudden blurry vision can be a symptom of various conditions, including stroke, but it is not a definitive indication for a stroke workup on its own 2.
- The most common presenting symptoms of ischemic stroke are speech disturbance and weakness on one-half of the body, not necessarily sudden blurry vision 2.
- However, vision loss can be a symptom of stroke, particularly if it is accompanied by other neurological deficits such as speech disturbance or weakness 2.
- Sudden vision loss can also be caused by other conditions such as acute angle-closure glaucoma, retinal detachment, retinal artery occlusion, giant cell arteritis, and optic neuritis 3.
- A diagnostic approach to sudden vision loss should include a thorough patient history, physical examination, and diagnostic studies to determine the underlying cause 3.
- Neuroimaging may be required to differentiate ischemic stroke from intracerebral hemorrhage, as well as to diagnose entities other than stroke 2.
- If a stroke is suspected, prompt evaluation and treatment are crucial to prevent further brain damage and improve outcomes 4, 5, 6.