Nineteen subjects with retinal strokes of different degrees of severity (amaurosis fugax, occlusion of individual retinal arteries or of the central retinal artery) were examined by continuous-wave Doppler sonography. Evaluation of periorbital Doppler flow and direct examination of the major neck vessels were performed. Twelve subjects presented with homolateral arteriosclerotic lesions at the carotid bifurcation. The ultrasonographic findings were confirmed by carotid arteriography. High-grade stenosis or occlusion of the internal carotid artery were found in approximately 50% of the patients; the remainder turned out to have low-grade stenoses or nonstenosing plaques. These findings emphasize the role of emboli from the major neck arteries in the pathogenesis of retinal and cerebral insults. Hemodynamic effects seem to be of minor significance. Continuous-wave Doppler sonography is a completely non invasive, but nevertheless reliable method for the detection of clinically relevant carotid lesions. Especially patients suffering from retinal insults should be examined by Doppler sonography, since they are at high risk for further cerebral stroke.
