Abstract WP332: Persistent Visual Deficits and Functional Outcomes After Minor Ischemic Stroke

Background: Compared to more severe presentations, minor ischemic stroke is less well characterized regarding factors associated with long-term outcomes. As a result, there remains a need to assess the impact of persistent visual deficits on functional disability in this population. This study aims to compare the functional outcomes of minor ischemic stroke among patients with persistent visual deficits compared to those of patients without visual deficits. Methods: This retrospective single-center cohort study included adult acute ischemic stroke patients who presented to a comprehensive stroke center from 2019 to 2023. Minor ischemic stroke was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≤ 5 on admission that remained ≤ 5 at 24 hours. Persistent visual deficits (PeVD) were defined as nonzero visual field NIHSS subscores at 24 hours. The primary outcome was the modified Rankin Scale (mRS) score at 90 days for minor stroke patients with and without PeVD. Results: Among 1041 patients with minor ischemic stroke, 108 (10.4%) had PeVD. Both the median presenting (PeVD+: 2 [IQR 1-4] v. PeVD-: 1 [IQR 0-3], p<0.001) and 24-hour NIHSS (PeVD+: 2 [IQR 1-3] v. PeVD-: 1 [IQR 0-2], p<0.001) were higher in PeVD+ vs. PeVD- patients. At 90 days, patients with PeVD had both higher mortality rates (14.3% vs. 7.8%, p=0.04) and mRS scores (p=0.003) compared to those without visual deficits. After multivariable regression and sensitivity analyses, 24-hour NIHSS was associated with worse 90-day functional outcomes (p<0.001) while the presence of PeVD was not associated with functional outcomes (p=0.21). Conclusion: The results of this study suggest that persistent visual deficits in patients with minor ischemic stroke are associated with increased stroke severity but may not be directly responsible for worse functional outcomes at 90 days. Future studies are needed to evaluate alternative functional outcome measures in patients with PeVD that are not captured by mRS but may significantly impact quality of life.