Amaurosis Fugax Associated with Ipsilateral Internal Carotid Artery Agenesis

PURPOSE: We report a case of amaurosis fugax associated with ipsilateral internal carotid artery agenesis. CASE SUMMARY: A 50-year-old woman presented with amaurosis fugax in her left eye; the frequency of episodes of the condition had recently increased to once a month. She had a history of hypertension and dyslipidemia, and was under medical therapy. The visual acuity of both eyes was 20/20. Slit-lamp examination was normal except for pseudophakia. Ophthalmoscopy revealed a myopic tigroid fundus and a myopic tilted disc. No abnormalities were evident in fluorescein fundus angiography. Brain computed tomography showed that the left bony carotid canal was absent, and magnetic resonance angiography showed that the left internal carotid artery was also absent. She was diagnosed with left internal carotid artery agenesis. Other neurological and hematological parameters were within normal ranges. The amaurosis fugax spontaneously disappeared and has not recurred over the past 12 months. Our case, although rare, suggests that amaurosis fugax may be associated with internal carotid artery agenesis.

Recurrent Transient Monocular Blindness Caused by Retinal Vasospasm

No abstract available.

Recurrent Transient Monocular Blindness Caused by Retinal Vasospasm

No abstract available.

Ocular and Systemic Manifestation of Amaurosis Fugax: Six-Year Observational Study

PURPOSE: To investigate the prevalence of ocular and systemic disease causing amaurosis fugax and to discuss the ocular and systemic manifestation of each disease. METHODS: Consecutive patients who had amaurosis fugax were retrospectively studied from 2007 to 2013. Carotid evaluation using Doppler was performed in all patients. Ocular and medical histories were taken and bilateral ophthalmic evaluation performed. RESULTS: This study included 35 patients. The mean age of patients was 63 years and 27 patients were male; 29 unilateral and 6 bilateral eyes were involved. Associated systemic disease included hypertension (54.3%) and diabetes mellitus (34.2%). The most frequent cause of amaurosis fugax was retinal artery occlusion (28.6%) followed by ocular ischemic syndrome (22.9%), other vascular diseases (11.4%), and retinal vein occlusion (5.7%). The remaining 31.4% patients with amaurosis fugax had no vascular disease. Clinically significant stenosis of the internal carotid artery was observed in 16 patients (45.7%) and 6 of these patients (37.5%) had retinal artery occlusion disease. CONCLUSIONS: Prevalence and clinical manifestation of amaurosis fugax is very complex. Patients with transient visual disturbance are at risk for retinal artery occlusion, ocular ischemic syndrome and other diseases which cause visual loss. Therefore, careful history taking and urgent systemic and ophthalmic evaluations should be performed.

Causas isquêmicas de perda de visão monocular transitória / Ischemical causes of transient monocular vision loss

A amaurose fugaz é um ataque isquêmico transitório da retina que pode aparecer como um preditor de doenças isquêmicas e não isquêmicas. Este trabalho visa revisar a perda de visão monocular transitória relacionada às doenças isquêmicas, cujo diagnóstico e o tratamento precoce são fundamentais para prevenir conseqüências futuras como o AVC e a perda visual permanente.

The amaurosis fugax is a transient ischemic attack of the retina that may appear as a predictor of ischemic and not ischemic disease. This paper aims to review the transient monocular vision loss related to ischemic heart disease, whose diagnosis and early treatment are key to preventing future consequences such as stroke and permanent visual loss.

Tumor of Meckel's Cave Presented With Recurrent Transient Monocular Blindness

No abstract available.

Transient Visual Loss in Peripapillary Staphyloma

PURPOSE: To report the case of a patient with transient visual loss with a peripapillary staphyloma. CASE SUMMARY: The authors of the present study examined a 30-year-old woman who complained of transient visual loss in her right eye. The patient lost her vision for 5 seconds on average approximately 5 times a day. Her visual acuity was 20/20 in both eyes. There were no abnormalities on slit lamp examination. A deep excavation with choroidal atrophy in the peripapillary area of the right eye was found. The patient was diagnosed with peripapillary staphyloma. Her physiological blind spot in the right eye was enlarged on Humphrey visual field testing. However, she had no abnormalities on color vision testing, fluorescein angiography, or magnetic resonance imaging (MRI). There were no abnormalities in the evaluation of the brain, carotid arteries, or heart. There was no evidence of vasculitis or hypercoagulability. The symptom did not change on pressing the eyeball, performing the Valsalva maneuver or carotid massage, applying cycloplegics, or shining a strong light in the other eye. The symptom did not change after taking a calcium channel blocker for 4 weeks.

Pérdida transitoria de la visión / Transient vision loss

La pérdida transitoria de la visión monocular (PTVM), es un síntoma alarmante relacionado frecuentemente con alteraciones vasculares retinales y puede tener consecuencias importantes desde el punto de vista ocular y vital. Es por ello, que se requiere de un manejo precoz y adecuado. El presente artículo tiene por objeto revisar las principales causas, su presentación, diagnóstico y manejo, como enfermedades oclusivas vasculares y alteraciones el nervio óptico entre otras

Transient monocular vision loss (TMVL) is an alarming symptom often in relation with retinal vascular anomalies that may have severe consequences for vision and life, so it should be evaluated urgently and a prompt approach is needed. This article will review the main causes, its presentation, diagnosis and management such as vascular occlusive diseases and optic nerve abnormalities among others

Valsalva Maneuver-induced Amaurosis Fugax

PURPOSE: To report the case of a patient with amaurosis fugax that occurred following a Valsalva maneuver. CASE SUMMARY: A 40-year-old man presented with amaurosis fugax of the right eye, which had occurred several times during the previous month. After coughing, the visual acuity of the right eye decreased temporarily during the first episode. Subsequently, any time a Valsalva maneuver, such as coughing, occurred, this symptom reappeared. Initially, this symptom persisted for five to ten minutes and occurred once or twice a day, but it gradually increased in frequency. The physical examination was normal, and his best corrected visual acuity was 20/20 bilaterally. Neither specific findings in the slit lamp examination nor abnormal findings in the fundus examination were detected. On fluorescein fundus angiography, no abnormal finding was observed before the symptom was triggered by a Valsalva maneuver, but after the symptom was triggered by coughing, the choroidal and retinal arterial phases were delayed. Hematological and neurological examinations, including magnetic resonance imaging, magnetic resonance angiography, and cerebral angiography, were all normal. Therefore, he was diagnosed with amaurosis fugax generated by a Valsalva maneuver. CONCLUSIONS: In any patient who complains of amaurosis fugax repeatedly, as seen in this case, one must consider the possibility that it results from a Valsalva maneuver, after eliminating occlusive vascular diseases, such as carotid stenosis or atherosclerotic disease.

Ocular Ischemic Syndrome Successfully Treated With Carotid Angioplasty and Stenting

PURPOSE: To report a case of ocular ischemic syndrome successfully treated with delayed carotid angioplasty and stenting (CAS). CASE SUMMARY: A 52-year-old male was admitted to our hospital because of amaurosis fugax-like symptoms in the right eye for several months. His visual acuity was 0.8 in the right eye and he did not have rubeosis iridis. Neovascularization of the disc, narrowing of the retinal artery and multiple retinal hemorrhages were diagnosed by fundus examination. Fluorescein angiography showed delayed choroidal filling, a delayed arm-to-retina time, prolongation of arteriovenous transit time, neovascularization of the disc, retinal capillary nonperfusion, and staining of the retinal vessels. MR angiography showed severe stenosis in the proximal portion of the right carotid artery. We diagnosed this case as ocular ischemic syndrome. The patient was recommended carotid angioplasty and stenting at the severely narrowed portion of the right carotid artery, but it was postponed about six months after diagnosis because of personal problems. At the final follow-up, 24 months after stenting, the amaurosis fugax symptoms had disappeared, the patient had an improved visual acuity of 1.0, and the new vessels on the disc changed to fibrous tissue. Fluorescein angiography showed resolution of the delayed arm-to-retina time and prolongation of the arteriovenous transit time, disappearances of the leakage around the disc and the retinal capillary nonperfusion.

A Case of Systemic Lupus Erythematosus Presenting with Amaurosis Fugax without Antiphospholipid Antibodies Syndrome / 영남의대학술지

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that may affect many organ systems including the nervous system. The immune response in patients with SLE can cause inflammation and other damage that can cause significant injury to the arteries and tissues. A 48-year-old woman was admitted to the hospital because of transient monocular blindness. Magnetic resonance imaging and conventional angiography showed severe stenosis of the distal intracranial internal carotid artery. The patient was diagnosed as having SLE but the antiphospholipid antibodies were negative. Amaurosis fugax has not been previously reported as an initial manifestation of SLE in Korea. We report a patient with a retinal transient ischemic attack as the first manifestation of SLE.

Amaurosis Fugax Associated with Stenosis of the Intracranial Internal Carotid Artery: Successful Restoration of Ophthalmic Artery Flow by Stent Placement

Two patients presented with amaurosis fugax(AMF), despite treatment with antiplatelet drugs and anticoagulants due to previous transient ischemic attacks. Angiography demonstrated severe stenosis in the cavernous and petrous internal carotid artery(ICA) respectively, with reduced flow in the ophthalmic artery(OA). Endovascular stent placement in both patients resulted in normalization of the vessel lumen of the stenotic vessel segments. In addition, complete restoration of OA flow was noted immediately after stenting. Both patients showed no further episode of AMF over a follow-up period of 38 and 23 months respectively. Our clinical and angiographic findings suggest that hemodynamic insufficiency in retinal vasculature caused by a stenosis of the cavernous or petrous ICA can be treated successfully by endovascular stent.

A Case of Recurrent Transient Monocular Blindness in Systemic Lupus Erythematosus patient with Antiphospholipid Antibody Syndrome

Transient monocular blindness (TMB) may occur in patients with systemic lupus erythematosus (SLE). Several mechanisms have been suspected as the causes of such TMBs. A 32-year-old female patient with SLE presented recurrent monocular altitudinal visual field defects lasting for several minutes and occurring less than six times per day. Her anticardiolipin antibody level was persistently positive. All cerebrovascular imagings were normal. We report a case of recurrent TMBs in SLE with antiphospholipid antibody syndrome, which may have been induced by vasospasm.

Enfermedad cerebrovascular: doce años de experiencia en el tratamiento quirúrgico de la obstrucción carotídea / Cerebrovascular disease: a 12 year experience in the surgical treatment of carotid obstruction

Introducción: se consideró prudente revisar el tema y la casuística de doce años por los autores en pacientes con infarto cerebral por enfermedad carotídea, por la elevada morbilidad y mortalidad así como la frecuencia de secuelas incapacitantes.Material y método: presentamos nuestra experiencia en el Hospital ABC de junio de 1988 a junio del 2000, en el tratamiento quirúrgico de la obstrucción carotídea en 63 pacientes (33 Fem. y 30 Masc.), con edad promedio de 70 años, que requirieron 68 endarterectomías. Sus factores de riesgo incluían: hipertensión arterial 40 Ptes., tabaquismo 40, cardiopatía isquémica 22, neumopatía 12 y diabetes m. 10. Fueron 40 endarterectomías izquierdas y 28 derechas; 61 por estenosis sintomática y 7 asintomáticas. Los principales síntomas fueron: ataques de isquemia cerebral transitoria 39, infarto cerebral previo 13 y amaurosis fugax 9. El porcentaje promedio de estenosis en las lesiones sintomáticas fue de 86.47 por ciento y en las asintomáticas de 82 por ciento. Resultados: todos los pacientes fueron operados bajo anestesia general endotraqueal, con protección cerebral farmacológica, monitorización electroencefalográfica y de potenciales evocados somatosensoriales. Nueve casos (13.23 por ciento) requirieron la colocación de una derivación (shunt) transoperatoria. El tiempo promedio de pinzamiento carotídeo fue en los pacientes sin derivación 35.8 minutos y con derivación 4 minutos. Siete casos, todos del sexo femenino, requirieron arteriorrafia con parche; 4 con dacrón, 2 con PTFE y 1 con vena safena. El tiempo promedio de cirugía fue de 2 horas 37 minutos. Mortalidad operatoria 1 caso (1.47 por ciento) por fibrilación ventricular secundaria a infarto agudo del miocardio. Morbilidad neurológica central 1 caso. Morbilidad neurológica periférica 2 casos por lesión neuropráxica del recurrente laríngeo y del facial con recuperación completa. Morbilidad no neurológica 9 casos (13.23 por ciento): HTA postoperatoria 4, hipotensión arterial postoperatoria 3, hematoma 1 e IAM 1.El tiempo promedio de estancia hospitalaria fue de 4.52 días. Discusión: los resultados de esta serie de endarterectomías carotídeas con pacientes cuya edad promedio fue la 8a. década de la vida, con ASA III en 47 por ciento de los casos, donde 89.7 por ciento presentaba estenosis sintomáticas de 86.47 por ciento promedio, muestran baja mortalidad operatoria y morbilidad neurológica central, equiparables a los resultados de los estudios NASCET y ACAS.

Amaurose fugaz após introflexão escleral / Fugax amaurosis after scleral buckling surgery

Objetivo: Apresentar dois casos de amaurose fugaz após introflexão escleral e discutir sua possível fisiopatologia. Local: Instituto de Oftalmologia Tadeu Cvintal. Método: Pacientes submetidos à retinopexia por introflexão escleral que cursaram com amaurose fugaz no pós-operatório correlacionados à elevação da pressão intra-ocular. Conclusão: Perda visual transitória pode estar entre as complicações pós-operatórias de introflexão escleral e através do controle da pressão intra-ocular tal situação pode ser reversível.

A Case of Internal Carotid Artery Dissection Presenting with Isolated Hypoglossal Nerve Palsy

Neurological manifestations of internal carotid aretry (ICA) dissection include amaurosis fugax, cerebral ischemia, oculosympathetic paresis, and various cranial nerve palsies. Isolated hypoglossal nerve palsy is a rare manifestation of ICA dissection. A 55-year-old man developed dysarthria following sudden pain in the left retroauricular area. His tongue was paralysed on the left side. Magnetic resonance image and carotid angiogram showed characteristic features of left ICA dissection, which may be the most plausible cause of hypoglossal nerve palsy in this patient. Expanding hematoma of dissecting aneurysm of ICA seems to have compressed the nutrient artery of the hypoglossal nerve, although the possibility of direct compression of the hypoglossal nerve itself is not completely ruled out.

Prevalence of Asymptomatic Carotid Atherosclerosis in Korea

PURPOSE: To investigate the prevalence and risk factors of atherosclerotic disease of the extracranial carotid artery in healthy Korean population. METHODS: Eight hundred twenty-five patients without previous history of transient ischemic attack, amaurosis fugax, and/or any neurologic deficit who underwent carotid artery ultrasonography were evaluated retrospectively. The patients were divided into five groups according to the degree of carotid artery stenosis using real-time B-mode high resolution ultrasonography; Group A-normal carotid artery, Group B-below 30% of carotid artery stenosis, Group C-from 31% to 50% of carotid artery stenosis, Group D-from 51% to 70% of carotid artery stenosis, Group E-above 71% of carotid artery stenosis. Medical Records of all patients were investigated for following factors; sex, age, family history, smoking, hypertension, diabetes mellitus, total cholesterol, HDL- cholesterol, LDL-cholesterol, TG (triglyceride), HbA-1c (hemoglobin A-1c), and folate. RESULTS: 12.5% of asymptomatic patients have carotid stenosis due to atherosclerosis of extracranial carotid artery. The prevalence of extracranial carotid artery stenosis was as follows; Group B: 2.2%, Group C: 7.0%, Group D: 3.0%. The age, total cholesterol, LDL-cholesterol and HbA-1c were significantly higher in Group B, C, D than Group A (P=0.001, 0.016, 0.011, 0.001). The prevalence of diabetes and hypertension were significantly higher in Group B, C, D than Group A. Other factors, however, were not different among the groups. CONCLUSION: Asymptomatic carotid artherosclerosis is not uncommon in Korea. Carotid ultrasonography would be necessary for patients with hypertension, diabetes, and high serum cholesterol level.

A Case of Cavernous ICA Occlusion after Radiation Therapy in Pituitary Adenoma

Stenosis or occlusion of large arteries after radiation are rare. The authors report a case of internal carotid arterial occlusion after radiation therapy. The patient was 45 year-old female. She received postoperative radiation therapy, a total dose of 4940cGy, to treat the remnant tumor after transsphenoidal surgery for the asymptomatic nonfunctioning pituitary adenoma. She suffered intermittant ischemic symptoms from 18 month after radiation therapy, and died with global infarction due to stenotic occlusion of the internal carotid artery at 30 month after surgery. Endocrine or vascular complications occasionally follow radiation therapy of pituitary tumor. But with improved therapies for pituitary tumors and hypopituitarism, patients are expect to live longer. Yet we must consider another delayed complication of radiation induced carotid arterial disease. As a whole, hemispheric transient ischemic attacks, amaurosis fugax, and seizure are the major presenting symptoms and signs. In such a case, it is important to consider the possibility of radiation induced arterial stenosis, and prompt cerebral angiography and proper management are mandatory.

Primary antiphospholipid syndrome associated with non-ischemic central retinal vein occlusion

Antiphospholipid syndrome is a disease producing vascular thrombosis with antiphospholipid antibody and usually associated with systemic lupus erythematosus. It is called primary antiphospholipid syndrome(PAPS) if it does not have the clinical features of collagen vascular disorder. Ocular manifestations of antiphospholipid syndrome include retinal vascular disorder, anterior ischemic optic neuropathy, and amaurosis fugax. Ocular manifestations are much less common in primary antiphospholiped syndrme than antiphospholipid syndrome associated with systemic lupus erythematosus. We experienced two cases of non-ischemic central retinal vein occlusion which were associated with primary anti phospholipid syndrome in two female patients, who complained sudden decrease of visual acuity in one eye. We report the cases with review of the literatures.