ABSTRACT
Background: We report a case of reversed ophthalmic artery (OA) flow showing neither occlusion of the internal carotid artery (ICA) nor ophthalmic symptoms.Case: An 82-year-old man had transient blindness in both eyes. After left carotid endarterectomy, ophthalmic symptoms improved in the right and left eyes. Afterwards, he had a relapse in the left eye.Results: There was no unusual impression in the ophthalmic examinations, but color Doppler imaging showed reduced flow in the left OA, reversal of flow direction in the right OA. The central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were not detected in the left eye but were detected in the right eye. Digital subtraction angiography demonstrated that the right OA was not contrasted with the right ICA, despite there being no stenosis or occlusion of the right ICA.Conclusions: We suggest that carotid surgery may affect the ocular circulation of the opposite side, and reversed OA flow as a collateral pathway from the external carotid artery may occur in the absence of carotid artery stenosis. Good circulation of the CRA and SPCA may preclude manifestation of ophthalmic symptoms even if the OA flow is reversed.
ABSTRACT
BACKGROUND: We report a case of reversed ophthalmic artery (OA) flow showing neither occlusion of the internal carotid artery (ICA) nor ophthalmic symptoms. CASE: An 82-year-old man had transient blindness in both eyes. After left carotid endarterectomy, ophthalmic symptoms improved in the right and left eyes. Afterwards, he had a relapse in the left eye. RESULTS: There was no unusual impression in the ophthalmic examinations, but color Doppler imaging showed reduced flow in the left OA, reversal of flow direction in the right OA. The central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were not detected in the left eye but were detected in the right eye. Digital subtraction angiography demonstrated that the right OA was not contrasted with the right ICA, despite there being no stenosis or occlusion of the right ICA. CONCLUSIONS: We suggest that carotid surgery may affect the ocular circulation of the opposite side, and reversed OA flow as a collateral pathway from the external carotid artery may occur in the absence of carotid artery stenosis. Good circulation of the CRA and SPCA may preclude manifestation of ophthalmic symptoms even if the OA flow is reversed.
Subject(s)
Carotid Stenosis/surgery , Ophthalmic Artery/physiopathology , Aged , Aged, 80 and over , Angiography, Digital Subtraction , Collateral Circulation , Endarterectomy, Carotid , Functional Laterality , Humans , Male , Ophthalmic Artery/diagnostic imagingABSTRACT
Seven acute leukemia cases with oculomotor paralysis and/or optic nerve paralysis were reported. Five cases were lymphoblastic and two were myelogenous leukemia. The average age was 30.7 years old and male to female ratio was 5:2. The eye involvement developed during hematological complete remission stage in 4 cases, and during relapsing stage in 2 cases. For the remaining case, eye symptom was an initial symptom of the disease. The computed tomography of ocular region showed tumorous involvement in 3 cases and no abnormality in other 4 cases. The white blood cell count on admission was over 30,000/microliters and leukemic cells occupied over 59% of bone marrow nucleated cells in 5 cases. Intrathecal administration, a whole brain irradiation and intra-arterial injection of Nimustin as well as standard systemic chemotherapy were performed against oculomotor and optic nerve involvement. Leucoencephalopathy occurred in 2 of 7 cases after intrathecal administration and irradiation. Since 1980, continuous treatment for prophylaxis of central nervous system leukemia have been done and this protocol was effective for meningeal involvement but not for ocular involvement.
