Does a patient with a posterior eye stroke (stroke behind the eye) need to see a neurologist after hospital discharge?

Neurological Follow-Up for Patients with Posterior Eye Stroke After Hospital Discharge

Yes, patients with posterior eye stroke (retinal artery occlusion) should see a neurologist after hospital discharge as this condition is considered a form of ischemic stroke requiring comprehensive follow-up care and secondary stroke prevention.

Rationale for Neurological Follow-Up

Central retinal artery occlusion (CRAO) and other forms of ocular stroke are recognized by the American Heart Association as forms of ischemic stroke that require specialized care 1. These conditions share similar pathophysiology with cerebral strokes and indicate increased risk for future cerebrovascular events.

Key reasons for neurological follow-up:

1. Risk of recurrent stroke: Patients with ocular stroke have a significantly elevated risk of subsequent cerebrovascular events
2. Need for comprehensive evaluation: Neurologists provide specialized assessment of stroke etiology and risk factors
3. Secondary prevention: Neurological follow-up ensures appropriate preventive measures are implemented

Evidence-Based Recommendations

The American Heart Association/American Stroke Association guidelines recommend that individuals with stroke discharged from acute and postacute hospitals receive formal follow-up within 30 days of discharge 2. This follow-up should assess:

• Activities of daily living (ADL) status
• Communication abilities
• Functional mobility

For patients with ocular stroke specifically, the International Stroke Society recommends:

• Urgent neurological evaluation
• Comprehensive stroke workup including brain imaging and vascular studies
• Cardiac evaluation to identify potential embolic sources 1

Multidisciplinary Approach to Care

Optimal management of ocular stroke requires coordination between multiple specialists:

• Ophthalmologist: For monitoring vision, assessing for neovascularization, and managing ocular complications
• Neurologist: For stroke workup, secondary prevention, and monitoring for neurological complications
• Primary care physician: For risk factor management and coordination of care

Studies have demonstrated that neurologist involvement in stroke care leads to:

• More comprehensive diagnostic testing
• Lower mortality rates (5.6% vs 13.5%)
• Better functional outcomes at discharge (46.1% vs 57.1% dead or dependent) 3

Follow-Up Timeline and Components

1. Initial neurological follow-up: Within 2 weeks of discharge 1

   • Review of diagnostic test results
   • Optimization of secondary prevention strategies

2. Comprehensive assessment within 30 days 2:

   • Evaluation of functional status
   • Assessment of communication abilities
   • Review of medication adherence and effects

3. Ongoing follow-up:

   • Regular monitoring of neurological status
   • Adjustment of preventive medications as needed
   • Coordination with ophthalmology for vision monitoring

Barriers to Appropriate Follow-Up

Despite these recommendations, research indicates that referral for specialized follow-up after visual field defects is often inadequate. A Norwegian study found that only 9.6% of stroke patients with visual field defects were referred for specialized visual assessment, and only 2.3% received visual rehabilitation 4.

Factors associated with lower referral rates included:

• Advanced age
• Female gender
• Higher disability scores
• Greater stroke severity

Conclusion

Neurological follow-up is essential for patients with ocular stroke after hospital discharge. This follow-up should be arranged within 2 weeks of discharge to ensure appropriate secondary prevention measures are implemented and to coordinate multidisciplinary care. Failure to provide this follow-up may result in missed opportunities for preventing future strokes and optimizing functional outcomes.