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Stroke and Vascular Neurology Dec 2017A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the... (Review)
Review
A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the most disabling residual effect after a cerebral infarction. Transient vision problems can likewise be a harbinger of stroke and prompt evaluation after recognition of visual symptoms can prevent future vascular injury. In this review, we discuss the visual aspects of stroke. First, anatomy and the vascular supply of the visual system are considered. Then, the different stroke syndromes which involve vision are discussed. Finally, topics involving the assessment, prognosis, treatment and therapeutic intervention of vision-specific stroke topics are reviewed.
Topics: Animals; Eye; Humans; Prognosis; Regional Blood Flow; Stroke; Vision Disorders; Vision, Ocular; Visual Pathways
PubMed: 29507782
DOI: 10.1136/svn-2017-000079 -
Case Reports in Oncology 2021Oxaliplatin-associated amaurosis fugax has not been reported, and its clinical course and treatment remain largely unclear. A 70-year-old man with advanced gastric...
Oxaliplatin-associated amaurosis fugax has not been reported, and its clinical course and treatment remain largely unclear. A 70-year-old man with advanced gastric cancer was treated with the SOX regimen. After cycle 1 of oxaliplatin infusion, the patient realized that his right eye had visual field impairment, which he described as darkening of the right half of his visual field and loss of vision lasting about 1 min and occurring about 7 times a day. The daily frequency of this occurrence gradually decreased, and his visual field impairment improved in 1 week. However, as the same symptoms recurred from cycle 2 to cycle 5 of treatment, oxaliplatin was discontinued from cycle 6 and switched to S-1 monotherapy. Subsequently, the patient's amaurosis fugax improved. To our knowledge, this is the first report describing clinical course and treatment of oxaliplatin-associated amaurosis fugax.
PubMed: 34248547
DOI: 10.1159/000516271 -
British Journal of Hospital Medicine... Aug 2022
Topics: Amaurosis Fugax; Carotid Artery Diseases; Humans; Ischemic Attack, Transient
PubMed: 36066290
DOI: 10.12968/hmed.2021.0654 -
Asia-Pacific Journal of Ophthalmology...Transient ischemic attack (TIA) is defined as a transient episode of neurological dysfunction resulting from focal brain, spinal cord, or retinal ischemia, without... (Review)
Review
Transient ischemic attack (TIA) is defined as a transient episode of neurological dysfunction resulting from focal brain, spinal cord, or retinal ischemia, without associated infarction. Consequently, a TIA encompasses amaurosis fugax (AF) that is a term used to denote momentary visual loss from transient retinal ischemia. In this review, we use the word TIA to refer to both cerebral TIAs (occurring in the brain) and AF (occurring in the retina). We summarize the key components of a comprehensive evaluation and management of patients presenting with cerebral and retinal TIA.All TIAs should be treated as medical emergencies, as they may herald permanent disabling visual loss and devastating hemispheric or vertebrobasilar ischemic stroke. Patients with suspected TIA should be expeditiously evaluated in the same manner as those with an acute stroke. This should include a detailed history and examination followed by specific diagnostic studies. Imaging of the brain and extracranial and intracranial blood vessels forms the cornerstone of diagnostic workup of TIA. Cardiac investigations and serum studies to evaluate for etiological risk factors are also recommended.The management of all TIAs, whether cerebral or retinal, is similar and should focus on stroke prevention strategies, which we have categorized into general and specific measures. General measures include the initiation of appropriate antiplatelet therapy, encouraging a healthy lifestyle, and managing traditional risk factors, such as hypertension, dyslipidemia, and diabetes. Specific management measures require the identification of a specific TIA etiology, such as moderate-severe (greater than 50% of stenosis) symptomatic extracranial large vessel or intracranial steno-occlusive atherosclerotic disease, aortic arch atherosclerosis, and atrial fibrillation.
Topics: Amaurosis Fugax; Brain; Humans; Ischemic Attack, Transient; Risk Factors; Stroke
PubMed: 35213421
DOI: 10.1097/APO.0000000000000511 -
British Medical Journal (Clinical... Oct 1982
Topics: Blindness; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Time Factors
PubMed: 6812749
DOI: 10.1136/bmj.285.6348.1066 -
Clinical Ophthalmology (Auckland, N.Z.) 2016The purpose of this study was to describe clinical characteristics and prevalence of carotid stenosis in patients with amaurosis fugax (AF).
PURPOSE
The purpose of this study was to describe clinical characteristics and prevalence of carotid stenosis in patients with amaurosis fugax (AF).
METHOD
Patients diagnosed with AF and subjected to carotid ultrasound in 2004-2010 in Sahlgrenska University Hospital, Gothenburg (n=302), were included, and data were retrospectively collected from medical records.
RESULTS
The prevalence of significant carotid stenosis was 18.9%, and 14.2% of the subjects were subjected to carotid endarterectomy. Significant associations with risk of having ≥70% stenosis were male sex (adjusted odds ratio [aOR]: 2.62; 95% confidence interval [CI]: 1.26-5.46), current smoking (aOR: 6.26; 95% CI: 2.62-14.93), diabetes (aOR: 3.68; 95% CI: 1.37-9.90) and previous vasculitis (aOR: 10.78; 95% CI: 1.36-85.5). A majority of the patients (81.4%) was seen by an ophthalmologist prior to the first ultrasound. Only 1.7% of the patients exhibited retinal artery emboli at examination.
CONCLUSION
The prevalence of carotid stenosis among patients with AF is higher than has previously been demonstrated in stroke patients. An association with previously reported vascular risk factors and with vasculitis is seen in this patient group. Ocular findings are scarce.
PubMed: 27826182
DOI: 10.2147/OPTH.S115656 -
Annals of Translational Medicine Oct 2020The timing of carotid endarterectomy (CEA) for symptomatic ipsilateral carotid artery stenosis has evolved in practice over time. Key landmark trials outlined the... (Review)
Review
The timing of carotid endarterectomy (CEA) for symptomatic ipsilateral carotid artery stenosis has evolved in practice over time. Key landmark trials outlined the benefit of performing CEA in the recently symptomatic carotid artery stenosis, defined as revascularisation within 6 months of the index neurological event. Further evidence and sub-analysis demonstrate that performing CEA within 2 weeks of symptoms has the maximal benefit in reducing stroke free survival and is associated with a safe perioperative complication profile. This has translated into guideline recommendations and widespread clinical practice. The case for performing urgent CEA (within 48 hours of index neurological event) over early CEA (within 2 weeks) has been put forward and studied. Data examining perioperative complications for urgent CEA are mostly derived from retrospective single series studies. A moderate balance exists in the literature for the safety and risk of urgent CEA. Although many studies present acceptable perioperative stroke and mortality rates associated with urgent CEA, evidence still exists that the perioperative complications may not be insignificant. This is particularly the case if the presenting neurology is a stroke, rather than a transient ischaemic attack (TIA) or amaurosis fugax. This should be contextualised in the practice of modern aggressive medical therapy with dual antiplatelets and statins, with evidence suggesting a reduction in recurrent ischaemic events prior to surgical intervention. Careful patient selection, presenting neurology and medical therapy is likely to be a key feature in considering urgent CEA versus early CEA.
PubMed: 33178799
DOI: 10.21037/atm-20-1130 -
Journal of Clinical Medicine Aug 2022To determine the associations among carotid stenosis, stroke, and myocardial infarction (MI) in patients with amaurosis fugax (AF).
BACKGROUND
To determine the associations among carotid stenosis, stroke, and myocardial infarction (MI) in patients with amaurosis fugax (AF).
METHODS
We retrospectively reviewed the records of patients diagnosed as having AF between January 2000 and December 2019. Among 14,857 patients with AF initially reviewed in the database, only 173 were ultimately enrolled, after excluding patients with wrong diagnosis, insufficient medical records, or loss of follow-up.
RESULTS
Of the 173 patients with AF, 61 (35.3%) had carotid stenosis, and among them, 18 (10.4%) had severe stenosis. In multivariate regression analysis, carotid stenosis was significantly associated with age ( = 0.009), male sex ( = 0.006), and ischemic heart disease ( = 0.039). Sixteen (9.2%) patients experienced a stroke after AF diagnosis (mean time to stroke: 23.1 ± 31.1 months, range: 1 day~85 month), 11 (68.8%) of whom had carotid artery stenosis ( = 0.003). Three (1.7%) patients had MI after AF (mean time to MI: 24.8 ± 35.9 months, range: 12 days~66 months), none of whom had carotid artery stenosis ( = 0.553). Four (2.3%) patients had central retinal artery occlusion (CRAO) after AF, all of whom had carotid artery stenosis ( = 0.034).
CONCLUSIONS
A high incidence of internal carotid artery stenosis was observed after AF attack and was significantly associated with stroke. The incidence of MI and CRAO after AF was low. Among them, only CRAO was associated with carotid artery stenosis.
PubMed: 36079019
DOI: 10.3390/jcm11175088