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Case Reports in Vascular Medicine 2012Purpose. A transient painless monocular visual loss due to a decrease in retinal circulation-also known as "amaurosis fugax"-often precedes acute territorial cerebral...
Purpose. A transient painless monocular visual loss due to a decrease in retinal circulation-also known as "amaurosis fugax"-often precedes acute territorial cerebral ischaemia. The case we present underlines the importance of a comprehensive diagnostic workup in patients with amaurosis fugax. Case Report. A 44-year-old man who had suffered from a dissection of the ascending aorta (Stanford Type A) five months ago presented with recurrent monocular vision problems. Episodes with sectional vision loss mainly occurred in combination with low blood pressure levels. Furthermore, the haemoglobin level was chronically low (Hb 9.7 mg/dL), and the patient was by mistake on a simultaneous therapy with phenprocoumon and unfractionated heparin. Carotid artery duplex scanning revealed a high-grade stenosis of the proximal right common carotid artery. MR imaging corroborated hypoperfusion in brain area corresponding to the right MCA. Conclusion. Our patient is an example in whom transient retinal ischaemic attacks may originate from haemodynamic reasons.
PubMed: 23198268
DOI: 10.1155/2012/254204 -
Interactive Cardiovascular and Thoracic... Mar 2013Ischaemic stroke represents a major health hazard in the western world, which has a severe impact on society and the health-care system. Roughly, 10% of all first... (Review)
Review
Ischaemic stroke represents a major health hazard in the western world, which has a severe impact on society and the health-care system. Roughly, 10% of all first ischaemic strokes can be attributed to significant atherosclerotic disease of the carotid arteries. Correct management of these lesions is essential in the prevention and treatment of carotid disease-related ischaemic events. The close relationship between diagnosis and medical and surgical management makes it necessary that all involved physicians and surgeons have profound knowledge of management strategies beyond their specific speciality. Continuous improvement in pharmacological therapy and operative techniques as well as frequently changing guidelines represent a constant challenge for the individual health-care professional. This review gives a thorough outline of the up-to-date evidence-based management of carotid artery disease and discusses its current controversies.
Topics: Amaurosis Fugax; Angioplasty; Asymptomatic Diseases; Cardiovascular Agents; Carotid Stenosis; Endarterectomy, Carotid; Hemodynamics; Humans; Ischemic Attack, Transient; Patient Selection; Predictive Value of Tests; Risk Assessment; Risk Factors; Risk Reduction Behavior; Severity of Illness Index; Stents; Stroke; Treatment Outcome
PubMed: 23197661
DOI: 10.1093/icvts/ivs453 -
Journal of Neurology Jul 2021The presence of livedo reticularis in patients with ischaemic stroke is associated with Sneddon syndrome (SS). Our objective was to present the clinical features of SS...
BACKGROUND
The presence of livedo reticularis in patients with ischaemic stroke is associated with Sneddon syndrome (SS). Our objective was to present the clinical features of SS patients and to assess the role of antiphospholipid antibodies (APL).
METHODS
Consecutive patients, diagnosed with SS between 1996 and 2017, were retrospectively reviewed for their demographic, neurological, dermatological, cardiac and extracerebral vascular features. Diagnosis of SS was made only if other causes of stroke were excluded. Patients with and without APL were included and compared for their clinical features.
RESULTS
Fifty-three patients (79% female) were included, of whom 14 patients were APL-positive. Median age at diagnosis was 40 years. Approximately 60% of the patients had ≥ 3 cardiovascular risk factors. There were 129 previous vascular events (66 ischaemic strokes, 62 TIAs and 1 amaurosis fugax) during a median period of 2 years between the first event and diagnosis of SS. Skin biopsy was positive for SS in 29 patients (67%), mostly showing a thickened vessel wall with neovascularization in the deep dermis. After a median follow-up of 28 months, 4 patients, either on antiplatelet or oral anticoagulation therapy, had a recurrent stroke. There were few statistically significant differences between APL-negative and APL-positive patients, including the number of vascular events before diagnosis.
CONCLUSIONS
SS predominantly affects young women with a relatively large number of cardiovascular risk factors. Clinical features of SS are comparable across different studies. We found no differences in the main clinical features between APL-positive and APL-negative patients.
Topics: Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Brain Ischemia; Female; Humans; Male; Retrospective Studies; Sneddon Syndrome; Stroke
PubMed: 33515066
DOI: 10.1007/s00415-021-10407-x -
Cureus May 2021Tolosa-Hunt syndrome (THS) is a fascinating condition that is ipso facto a cavernous sinus syndome. As such it is associated with inflammation of the cavernous sinus...
Tolosa-Hunt syndrome (THS) is a fascinating condition that is ipso facto a cavernous sinus syndome. As such it is associated with inflammation of the cavernous sinus walls and contents with spread to contiguous structures such as the orbital apex and superior orbital fissure. Therefore it does not come as a surprise that there is overlap with the condition of orbital pseudotumor. Furthermore, the typical presentation of THS involves variable affliction of the contents of the cavernous sinus with ocular and facial pain, ophthalmoplegia, facial numbness and Horner syndrome. To our knowledge, we present one of the only reported cases of recurrent amaurosis fugax and transient visual obscurations secondary to THS. Despite being an odd-ball presentation, these manifestations make intuitive sense as we demonstrate luminal narrowing of the right carotid siphon in the setting of cavernous wall enhancement, peri-arteritis of the carotid siphon being well-documented pathologically in the literature. The basis for the transient visual obscurations is more speculative but worthy of further study.
PubMed: 34221749
DOI: 10.7759/cureus.15281 -
BMJ Case Reports Aug 2018A 66-year-old woman with chronic myeloid leukaemia in nilotinib-induced remission was diagnosed with amaurosis fugax, caused by carotid stenosis. Serum cholesterol was...
A 66-year-old woman with chronic myeloid leukaemia in nilotinib-induced remission was diagnosed with amaurosis fugax, caused by carotid stenosis. Serum cholesterol was 316 mg/dL (Low-Density Lipoprotein (LDL) cholesterol 213 mg/dL). Nilotinib was discontinued and replaced by interferon. Antiplatelet therapy and atorvastatin 40 mg/day were prescribed. Muscle pain and elevation of serum creatine kinase (CK) occurred; thus, atorvastatin was replaced by ezetimibe. Afterwards, muscle pain subsided and CK reverted to normal, but 2 years later serum cholesterol was still elevated at 218 mg/dL with LDL cholesterol 126 mg/dL. Simvastatin 5 mg/day was then started, but again muscle pain occurred and CK rose to 267 U/L. Simvastatin was stopped and serum cholesterol climbed to 252 mg/dL. Creatine was prescribed and simvastatin was reintroduced. Two months later, cholesterol was 171 mg/dL, CK was 72 U/L and there was no muscle pain. This case supports the view that creatine may prevent statin-induced myopathy.
Topics: Aged; Amaurosis Fugax; Anticholesteremic Agents; Carotid Stenosis; Cholesterol, LDL; Creatine; Drug Therapy, Combination; Ezetimibe; Female; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Myalgia; Pyrimidines; Simvastatin; Treatment Outcome
PubMed: 30150340
DOI: 10.1136/bcr-2018-225395 -
Anales Del Sistema Sanitario de Navarra 2008Transient or persistent loss of vision in one eye is a common and distinctive manifestation of occlusive vascular disease. Occasionally, both eyes are involved together... (Review)
Review
Transient or persistent loss of vision in one eye is a common and distinctive manifestation of occlusive vascular disease. Occasionally, both eyes are involved together or sequentially, with temporary or even permanent blindness. The internal carotid arteries supply blood to the organ of vision; therefore pathologies of those arteries caused by arteriosclerosis may have a direct influence on its functioning. The most common syndromes are temporary (amaurosis fugax) or constant reduction of visual acuity. In fundus examination central retinal artery occlusion and branch retinal artery occlusion are the most common diagnosis, while retinal vein occlusion, anterior ischemic optic neuropathy, ocular ischemic syndrome are less common. There are many clinical ophtlamological manifestations due to vascular brain damage. Proper recognition and diagnosis of the disease may protect the patient against serious life-threatening complications such as stroke.
Topics: Amaurosis Fugax; Humans; Ischemic Attack, Transient; Ophthalmoplegia; Optic Nerve Diseases
PubMed: 19169299
DOI: No ID Found -
Case Reports in Oncology 2022Oxaliplatin, a third-generation platinum-based agent, is a constitutive part of systemic treatment for colorectal cancer in adjuvant and metastatic settings. Ocular...
Oxaliplatin, a third-generation platinum-based agent, is a constitutive part of systemic treatment for colorectal cancer in adjuvant and metastatic settings. Ocular toxicity is an extremely rare adverse effect of Oxaliplatin. Ocular toxicities have been documented in the form of (a) common (≥1/100, <1/10) which include the conjunctivitis, unexpected lacrimation, blurry vision, blepharoptosis, and (b) uncommon (≥1/10,000, <1/1,000) which compromise the tunnel vision, idiosyncratic color perception, transient bilateral visual loss, and rarest phenomenon of Amaurosis fugax. Amaurosis fugax implies to any cause of transient, painless, unilateral visual loss; with the possible underlying mechanism of thrombo-embolic carotid plaque, hypoperfusion, or vasospasm of retinal vessels, due to hyperviscosity, and atherosclerotic vascular disease. To date, only a few case reports of Oxaliplatin-induced Amaurosis fugax have been published. We here-in report 3 cases who experienced Amaurosis fugax while receiving Oxaliplatin in our one of health board-based four hospitals.
PubMed: 35350803
DOI: 10.1159/000521842 -
Ophthalmology. Retina 2017To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders.
OBJECTIVE
To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders.
DESIGN
Cohort study.
SUBJECTS
614 consecutive patients (728 eyes) with ocular arterial occlusive disorders.
METHODS
At first visit, all patients had a detailed ophthalmic and medical history, comprehensive ophthalmic evaluation, and carotid artery evaluation (by Doppler/angiography) on the side of ocular arterial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit. Ocular arterial occlusive disorders were divided into central (CRAO) and branch (BRAO) retinal artery occlusion, ocular ischemic syndrome (OIS), non-arteritic anterior ischemic optic neuropathy (NA-AION) and amaurosis fugax (AF).
MAIN OUTCOME MEASURES
Carotid artery and echocardiographic abnormalities, and incidence of transient ischemic attack (TIA)/stroke and myocardial ischemia.
RESULTS
The study consists of a cohort of 266 eyes with NA-AION, 203 with CRAO, 127 with BRAO, 80 with OIS and 52 with AF. Carotid artery stenosis on the involved side was worse in AF and OIS compared to BRAO, CRAO, and NA-AION (p<0.0001). Presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO compared to NA-AION (p=0.002, p=0.003, and p=0.0003, respectively). Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO compared to only 3% of NA-AION patients (p<0.0001). TIA/stroke before or after onset of ocular condition occurred in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NA-AION, and 3% of BRAO patients. Kaplan-Meier estimate of the incidence of TIA /stroke within 3 months after onset was 6% (95% CI: 2%, 17%) for OIS, 3% (95% CI: 0.4%, 19%) for AF, and 1% (95% CI: 0.3%, 4.1%) for CRAO. Report of myocardial ischemia before or after onset of ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NA-AION patients.
CONCLUSIONS
The incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke and myocardial ischemia differ among various ocular arterial occlusive disorders. The role of embolism and hemodynamic disturbances caused by carotid artery disease in these disorders is discussed.
PubMed: 28547004
DOI: 10.1016/j.oret.2016.08.003 -
Cureus Aug 2022In amaurosis fugax, there is a sudden loss of vision in one eye. Patients gain their vision after a few minutes. The most common underlying cause is atherosclerosis of...
In amaurosis fugax, there is a sudden loss of vision in one eye. Patients gain their vision after a few minutes. The most common underlying cause is atherosclerosis of the internal carotid artery. Other underlying causes include vasospasm of the internal carotid artery, which leads to hypoperfusion and is seen in vasculitis, ocular migraines, and systemic lupus erythematosus. In this case study, a 44-year-old male with a past medical history of migraine with aura presented to the emergency room with transient vision loss in the left eye, which lasted for two minutes. A computed tomography scan of the brain was negative for stroke. The patient was treated with intravenous fluid, aspirin, and enoxaparin sodium and instructed to follow up with neurology. A medical emergency such as amaurosis fugax caused by ocular migraine must be managed aggressively, and prompt imaging is necessary to exclude other causes.
PubMed: 36158378
DOI: 10.7759/cureus.28272 -
Clinical and Applied... Jul 2005The aim of this study was to prospectively assess associations between amaurosis fugax, inherited thrombophilia, and acquired thrombophilia. Thrombophilia and...
The aim of this study was to prospectively assess associations between amaurosis fugax, inherited thrombophilia, and acquired thrombophilia. Thrombophilia and hypofibrinolysis were studied in 11 cases (eight women, three men; all white) with amaurosis fugax, 57 +/- 17 years old, selected by the absence of abnormal brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), magnetic resonance venography (MRV), ipsilateral internal carotid artery plaque, atrial fibrillation, or cardiac thrombus. Cases were compared to 78 healthy adult white controls (53 +/- 18 years old) for serologic measures, and by polymerase chain reaction to 248 healthy white controls (78 adults, 170 children) for gene mutations. All 11 cases had one or more familial thrombophilic coagulation disorder including one heterozygous for the G1691A factor V Leiden mutation, two with low free protein S, four with high factor VIII, three with resistance to activated protein C, three homozygous for the C677T methylenetetrahydrofolate reductase (MTHFR) mutation, two compound C677T-A1298C MTHFR heterozygotes, and three with hypofibrinolytic 4G4G homozygosity for the PAI-1 gene. The case with factor VIII of 160% had two other thrombophilias (compound MTHFR C677T-A1298C heterozygosity, resistance to activated protein C), and hypofibrinolytic high Lp(a). Thrombophilic C677T MTHFR homozygosity or compound C677T-A1298C heterozygosity was present in five of 10 (50%) cases vs. 30 of 248 (12%) controls, Fisher's p (p(f)) = .005. Thrombophilic factor VIII was high in four of 10 (40%) cases vs. 0 of 38 controls, p(f) = .001. Thrombophilic hyperestrogenemia in five of the eight women (four exogenous estrogen, one pregnant) may have interacted with inherited thrombophilia-hypofibrinolysis, promoting thrombus formation. In cases selected by the absence of abnormal brain magnetic resonance imaging, significant ipsilateral internal carotid artery plaque, atrial fibrillation, or cardiac thrombus, we speculate that amaurosis fugax can be caused by reversible (by anticoagulation) retinal artery thrombi associated with heritable thrombophilia and/or hypofibrinolysis, often augmented by estrogen-driven acquired thrombophilia.
Topics: Adult; Aged; Amaurosis Fugax; Amino Acid Substitution; Brain; Child; Factor VIII; Female; Genetic Carrier Screening; Homozygote; Humans; Magnetic Resonance Imaging; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Plasminogen Activator Inhibitor 1; Polymorphism, Single Nucleotide; Reference Values; Thrombophilia
PubMed: 16015408
DOI: 10.1177/107602960501100301