A/L Thiagarajah, Ramani
(2018)
Hypertensive retinopathy and the risk of hemorrhagic stroke.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Hemorrhagic stroke and hypertensive retinopathy are known end organ damage, with
hemorrhagic stroke having deleterious consequence to the patients. This study is to
correlate between hypertensive retinopathy and hemorrhagic stroke.
Methods
All patients with with hypertension with and without hemorrhagic stroke were recruited.
Funduscopic examination was performed and then graded based on Wong and Mitchell
hypertensive retinopathy classification. Clinical and radiological parameter included are
demography, vital signs, Glasgow Coma Scale(GCS) on admission, clot volume, site of
clot, Intra-Cerebral Hemorrhage (ICH) score and Glasgow Outcome Scale (GOS)
score. Data were collected and correlated with the severity of hypertensive retinopathy.
Results
Fifty hypertensive patient without hemorrhagic stroke and fifty one patients with
hemorrhagic stroke were recruited. In the hemorrhagic stroke group, 21 had low
severity (normal/mild retinopathy changes) accounting for 41.2% and 30 patients had
high severity (moderate and severe retinopathy). In the non hemorrhagic stroke patients
49 had low severity and 1 had high severity (p value 0.001). Low severity showed better
GCS score on admission as compared to high severity, (p value of 0.003). Low severity
also showed a clot volume less than 30ml, (p value 0.001) and also statistically
significant with an ICH score of between 0-2 in most of the patients, (p value 0.006).
Lastly, we compared the GOS score of patients and found a favourable outcome of
GOS score 4-5 in low severity retinopathy for 17 patients with only 4 having
unfavourable outcome (GOS score 1-3). As for high severity, 23 patients hadunfavourable outcome with 7 having favourable outcome, this was statistically
significant, (p value of 0.001).
Conclusion
Low severity retinopathy were found to have small clot volume and most likely treated
by medical management and better outcome. With high severity retinopathy had larger
clot volume and requiring surgical intervention and poorer outcome.
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