Abstract Number: Esoc2026a1162 Beyond the Retinal Spot Sign: A Rapid Combined Duplex Ultrasound Score Enhances Detection of Crao and Brao

Abstract Background and aims Spot sign of the retina in B mode ultrasound is a known proof of the central retinal artery or branch occlusion (CRAO/BRAO) and is said to exclude vasculitic cause. However, the diagnostic sensitivity currently reported for this examination is not high enough to translate into meaningful clinical consequences for acute therapy, including earlier thrombolysis. We evaluate the sensitivity of using duplex coded ultrasound to detect CRAO/BRAO. Methods All patients with CRAO or BRAO admitted to our stroke unit by ophthalmology department admitted between August 2025and January 2026 were screened with ultrasound of the macula and colour-coded doppler ultrasound of the A. retinalis for both eyes. We screened for retinal spot sign and for altered flow (no-flow, flow less than 50% on the contralateral side or elevated pulsation-index (PI)). Results We enrolled 16 patients (12 CRAO, 4 BRAO) with a clinical onset between one up to eight days. Percentage of female patient was 72%. Mean age was 71,5 years. Spot sign alone was detected in 13 patients (81%). Altered flow in duplex was detected in 12 patients (9 no-flow, 1 reduced flow and 2 high PI). A combined score of both items could detect 15 out of 16 Patients (93,75%). Conclusions A combined score acquired in a three-minute ultrasound-examination could shorten the work-up of CRAO and BRAO patients, optimizing the acute diagnostic and possible treatment with intravenous thrombolysis. Further investigations with patients with sudden, painless loss of vision in one eye (e.g. venous occlusion, retinal bleeding) are needed for further evaluation. Conflict of interest Stephan Hause: Nothing to disclose