Multi-mode images to assess posterior circulation ischemic stroke caused by bilateral vertebral artery dissection based on vascular ultrasound: A case report / 中国脑血管病杂志

The etiology of posterior circulation ischemic stroke caused by bilateral vertebral artery dissection ( VAD) is often difficult to detect. In this study, the authors report a case of posterior circulation ischemic stroke with a history of excessive back elevation of the neck. The dissection of bilateral vertebral arteries was detected by carotid Doppler ultrasonography and further confirmed by magnetic resonance imaging and high-resolution magnetic resonance imaging. After 6 months of standard administration of dual antiplatelet therapy, recanalization of the bilateral vertebral artery was achieved. It proves that the early diagnosis and standardized medical treatment of VAD can significantly improve patients' prognosis.

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.

Abnormal Systemic Findings in Patients with Acute Retinal Artery Occlusion

PURPOSE: Analyzing the systemic abnormal findings of acute retinal artery occlusion, to investigate what kinds of systemic evaluation must be performed in patients with acute retinal artery occlusion. METHODS: Thirty-three patients who had been diagnosed as acute retinal artery occlusion from July 1996 to June 2001 at Kyungpook National University Hospital were evaluated. Routine blood test, carotid doppler ultrasonography, echocardiography, routine anticoagulation study and antithrombin III assay were performed and serum protein S and protein C levels of these patients were checked. RESULTS: Seventeen of 33 were diagnosed as central retinal artery occlusion, 2 as ophthalmic artery occlusion, 10 as branch retinal artery occlusion, 4 as cilioretinal artery occlusion. Sixteen of 33 patients (48%) had abnormal findings on these systemic evaluation. Twenty-two patients had carotid doppler ultrasonography. Twelve of these 22 patients (54%) had atherosclerotic plaque in their carotid artery, and hemodynamically significant carotid stenosis (> or =60% of lumen) was found in six patients (27%). Only one patient had decreased serum levels of protein S and protein C. Two patients had abnormal findings of echocardiography. One patient had elevated serum hemoglobin and hematocrit, and so he was transferred to department of hematology and diagnosed as secondary polycythemia (Table 2). CONCLUSIONS: Many patients with acute retinal artery occlusion had various systemic disease. So, it is suggested that systemic evaluation of acute retinal artery occlusion be performed.