The clinical significance of the asymptomatic Hollenhorst plaque.

Sixty consecutive patients with visual complaints as the primary symptom of cerebrovascular insufficiency were evaluated with complete cerebral angiography (CCA). Eighteen patients referred for evaluation of asymptomatic Hollenhorst plaques had a 50% incidence of ipsilateral carotid bifurcation disease, but only 16% of these were considered surgically remediable; five of these patients eventually required carotid endarterectomy (CEA). Nine of the 18 patients with asymptomatic Hollenhorst plaques were further evaluated with serial ocular fundus photography: the plaque persisted in all nine patients--in four for more than 6 months and in five for more than 1 year. No patient had transient or fixed retinal or cerebral symptoms. Twenty-six patients with amaurosis fugax showed a 70% incidence of significant bifurcation disease and three had significant intracranial disease; 50% eventually required CEA. Twelve patients with fixed visual deficits (four patients had homonymous hemianopsia, four had retinal artery occlusions, and four had ischemic retinopathies) demonstrated a 100% incidence of bifurcation disease, but in addition 85% had significant intracranial disease; only one of this group had surgically amenable disease. Amaurosis fugax preceded blindness in two patients. Hollenhorst plaque as an isolated phenomenon appears to be a retinal embolic event of uncertain age, with poor predictive power for further embolic events, and not as highly correlated with significant or surgically amenabe carotid bifurcation disease.