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Ophthalmology Feb 2022To determine the risk of stroke, transient ischemic attack (TIA), and transient monocular vision loss (TMVL) before and after a central retinal artery occlusion (CRAO).
PURPOSE
To determine the risk of stroke, transient ischemic attack (TIA), and transient monocular vision loss (TMVL) before and after a central retinal artery occlusion (CRAO).
DESIGN
Population-based, retrospective case series.
PARTICIPANTS
Patients diagnosed with a CRAO in Olmsted County, Minnesota, from 1976 to 2016.
METHODS
Patients living in Olmsted County with a diagnosis code of CRAO from 1976 to 2016 were reviewed. New CRAOs were confirmed, and stroke, TIA, and TMVL events in the 15 days before and after CRAO were recorded.
MAIN OUTCOME MEASURES
Incidence of stroke, TIA, and TMVL events in the 15 days before and after CRAO.
RESULTS
Eighty-nine patients with a CRAO were identified, providing an annual incidence of 2.58/100 000 (95% confidence interval [CI], 2.04-3.11). Median age at the time of CRAO was 76 years (range, 46-100 years); 56.2% were male, and 89.9% of the cohort was White. In the 15 days before and after CRAO, there were 2 ischemic strokes (2.2%), 1 hemorrhagic stroke (1.1%), 2 TIAs (2.2%), and 9 TMVL events (10.1%). Starting in 1999, 15 of 45 patients underwent magnetic resonance imaging within 2 months of CRAO. One patient (6.7%) had evidence of asymptomatic diffusion restriction, and 9 patients (60%) had a remote infarct.
CONCLUSIONS
This population-based study demonstrated that the risk of symptomatic ischemic stroke is 2.2% in the 15 days before and after a CRAO, which is slightly lower than most studies from tertiary centers. These data should be considered as practice recommendations are developed regarding the urgency of neurovascular workup in patients with acute CRAO.
Topics: Aged; Aged, 80 and over; Amaurosis Fugax; Female; Humans; Incidence; Ischemic Attack, Transient; Magnetic Resonance Imaging; Male; Middle Aged; Minnesota; Retinal Artery Occlusion; Retrospective Studies; Risk Factors; Stroke; Visual Acuity
PubMed: 34303745
DOI: 10.1016/j.ophtha.2021.07.017 -
Acta Medica Portuguesa 2010Temporal arteritis is a systemic vasculitis mainly affecting large and medium sized vessels, temporal artery in particular. The authors report the case of a male who...
Temporal arteritis is a systemic vasculitis mainly affecting large and medium sized vessels, temporal artery in particular. The authors report the case of a male who presented with large painful scalp ulcers over the temporo-parietal area, ipsilateral headache, amaurosis fugax and jaw claudication. Temporal arteries were thickened, painful and pulseless. Laboratory work revealed erythrocyte sedimentation rate of 63 mm and normochromic and normocytic anaemia. On histopathology transmural acute and chronic inflammation and multiple giant cells were patent in temporal artery wall. Ophthalmologic observation revealed significant visual impairment, mainly on the right eye. Regarding temporal arthritis diagnosis, prednisolone 1 mg/Kg/day was introduced. Clinical improvement was outstanding, although visual impairment remained. This case emphasizes early diagnosis and treatment importance in the avoidance of definitive sequela.
Topics: Aged; Giant Cell Arteritis; Humans; Male; Pain; Scalp Dermatoses; Skin Ulcer
PubMed: 20470480
DOI: No ID Found -
International Journal of Ophthalmology 2013To analyse previous literature and to formulate a management strategy for iris microhaemangiomas (IMH).
AIM
To analyse previous literature and to formulate a management strategy for iris microhaemangiomas (IMH).
METHODS
A review of the literature in English language articles on IMH.
RESULTS
Thirty five English language articles fulfilled the criteria for inclusion to the study and based on the contents on these articles a management strategy was formulated. Age at presentation ranged from 42 to 80 years with no sex or racial predisposition. Most patients with IMH have no systemic disease but a higher incidence had been reported in patients with diabetes mellitus, myotonic dystrophy, chronic obstructive pulmonary disease (COPD) and several other systemic and ophthalmic co-morbidities. Most patients remained asymptomatic until they experienced a sudden blurring of vision due to a hyphaema. Some patients only develop a self-limiting single episode of hyphaema and therefore the laser or surgical photocoagulation of iris should be reserved for the cases complicated with recurrent hyphaema. In some patients, several laser photocoagulation sessions may be needed and the recurrent iris vascular tufts may require more aggressive treatment. Iris fluorescein angiography (IFA) is useful in identifying the true extent of the disease and helps to improve the precision of the laser treatment. Surgical excision (iridectomy) should only be considered in patients who fail to respond to repeated laser treatment. In some cases IMHs has been initially misdiagnosed as amaurosis fugax, iritis and Posner-Schlossman syndrome.
CONCLUSION
Owing to its scarcity, there is no good quality scientific evidence to support the management of IMH. The authors discuss the various treatment options and present a management strategy based on the previous literature for the management for this rare condition and its complications.
PubMed: 23638431
DOI: 10.3980/j.issn.2222-3959.2013.02.26 -
The British Journal of Ophthalmology Dec 1986
Topics: Aged; Blindness; Female; Humans; Hyphema; Male; Middle Aged; Pilocarpine
PubMed: 3801373
DOI: 10.1136/bjo.70.12.933-a -
The Cochrane Database of Systematic... 2003Antiplatelet drugs are effective and safe in a wide variety of patients at high risk of vascular ischaemic events. Among patients undergoing vascular surgical... (Review)
Review
BACKGROUND
Antiplatelet drugs are effective and safe in a wide variety of patients at high risk of vascular ischaemic events. Among patients undergoing vascular surgical procedures, these agents significantly reduce the risk of graft or native vessel occlusion. In this context we wished to examine their effects in patients after carotid endarterectomy (CEA).
OBJECTIVES
The objective of this review was to evaluate whether antiplatelet agents are safe and beneficial after endarterectomy of the internal carotid artery.
SEARCH STRATEGY
We searched the Cochrane Stroke Group Trials Register (last searched: 1 October 2002). In addition we performed comprehensive searches of the Cochrane Controlled Trials Register (Cochrane Library Issue 3, 2002), MEDLINE (January 1966 to September 2002) and EMBASE (January 1980 to September 2002), and checked all relevant papers for additional eligible studies.
SELECTION CRITERIA
We selected randomised, controlled, unconfounded trials comparing antiplatelet agents with control after carotid endarterectomy in symptomatic or asymptomatic carotid stenosis of different degrees. Treatment duration had to be at least 30 days after CEA. Follow-up should be at least three months.
DATA COLLECTION AND ANALYSIS
Two reviewers selected trials for inclusion, assessed trial quality, and extracted data independently from each other. From each trial we extracted, first the number of patients originally allocated to each treatment group, and, second the number of patients who met the criteria for each outcome (intention-to-treat analysis). We calculated a weighted estimate of the odds for each outcome event across studies using the Peto odds ratio method.
MAIN RESULTS
Six trials involving 907 patients were identified. For 'death (all causes)' the Peto odds ratio of 0.77 with a 95% confidence interval (CI) of 0.48-1.24 did not show a statistically significant difference between both treatment groups. For 'stroke (any)' the Peto odds ratio of 0.58 (95%CI: 0.34-0.98) indicated a statistically significant benefit in favour of antiplatelet drugs (p=0.04). Concerning the secondary outcome events 'vascular death', 'stroke or vascular death', 'serious vascular events', 'death or dependency', 'myocardial infarction', 'major extracranial haemorrhage', 'local haemorrhage requiring surgery', 'restenosis', 'TIA or amaurosis fugax', neither any benefit nor any hazard of antiplatelet drugs could be shown. For the outcome events 'intracranial haemorrhage', 'ischaemic stroke' and 'occurrence or progression of contralateral stenosis', data were either too sparse for meaningful analyses, or not available at all.
REVIEWER'S CONCLUSIONS
Our results may indicate that antiplatelet drugs did not significantly change the odds of 'death' but reduce the outcome 'stroke of any cause' in patients undergoing carotid endarterectomy. However, it can not be excluded that the beneficial effect in reducing stroke is due to chance. There is a suggestion that antiplatelets may increase the odds of haemorrhage, but there are currently too few data to quantify this effect.
Topics: Amaurosis Fugax; Brain Ischemia; Carotid Artery, Internal; Carotid Stenosis; Endarterectomy, Carotid; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors; Randomized Controlled Trials as Topic; Stroke
PubMed: 12917908
DOI: 10.1002/14651858.CD001458 -
Neurology India 2022Mechanical stimulation may lead to internal carotid artery (ICA) dissection and aneurysm.
BACKGROUND
Mechanical stimulation may lead to internal carotid artery (ICA) dissection and aneurysm.
CASE DESCRIPTION
We encountered a rare case of ICA dissection and aneurysm with prolonged styloid process (SP) fracture. A 37-year-old sales worker presented with right-sided amaurosis fugax. After admission to a nearby optical clinic, he was admitted to our hospital. Computed tomography angiography (CTA) and digital subtraction angiography showed dissection and apparent aneurysmal change in the right cervical portion of the ICA. CTA also showed elongated SPs, so we diagnosed Eagle's syndrome, and fracture of the right-side process. After 2 weeks of antiplatelet therapy, the aneurysm enlarged and dissection remained, so we treated the patient with coil embolization and stenting.
CONCLUSION
We encountered a rare case of ICA dissection and aneurysm with Eagle's syndrome. Endovascular treatment was performed because the SP was fractured.
Topics: Adult; Angiography, Digital Subtraction; Carotid Arteries; Carotid Artery, Internal; Carotid Artery, Internal, Dissection; Humans; Male; Ossification, Heterotopic; Temporal Bone
PubMed: 35263916
DOI: 10.4103/0028-3886.338648 -
Ceska a Slovenska Oftalmologie :... 2017The value of ICT is important in diagnosis of the diseases of the eye and orbit Methods for direct measurement of intracranial pressure (ICT) are exact, but they are...
UNLABELLED
The value of ICT is important in diagnosis of the diseases of the eye and orbit Methods for direct measurement of intracranial pressure (ICT) are exact, but they are invasive and there is some risk of infection and damage of the tissue. Currently there are 2 valid indirect methods of mesurement of IKT. Digital Ophthalmodynamometry (D-ODM) and Transcranial Doppler ultrasonography (TDU). D-ODM is a non-invasive method for measuring of the Pulsating Venous Pressure (VPT). We can measure VPT by the pulse phenomena. Physiologically (to be maintained blood flow) VPT not be less than the ICT and intraorbital pressure (IorbitT). If we raise the VPT to compensate the current IKT (or IorbitT) - there is a pulsation VCR. We can calculate aproxymative IKT with the formula: IKT = 0.903 - (VPT) - 8.87, or IKT = 0.29 + 0.74 (VOT / PI (AO)). [VOT = intraocular pressure. PI - pulsatility index arteriae ophthalmic from Color Doppler ultrasonography.] IKT can be approximate calculate with mathematical formulas: IKT = 0:55 × BMI (kg / m2) + 0.16 × KTD (mmHg) - 0:18 x age (years) - 1.91. [KTD - diastolic blood pressure, BMI - Body master index] or: IKT = 16.95 x 0.39 x OSASW09 + BMI + 0.14 + TKS - 20.90. [OSASW095: width of the orbital arachnoid space at a distance of 9 mm behind the eyeball (nuclear magnetic resonance). BMI: Body Mass Index. TKS: mean arterial pressure]. Normal values of VPT are under 15 torr. The risk of increased intracranial pressure is above 20 torr. Under physiological conditions, there is intraocular pressure lower in about 5 torr than VPT.
CONCLUSION
D-ODM is a useful screening method in the evaluation of IKT for hydrocephalus, brain tumors, cerebral hemorrhage after brain trauma and also in ocular diseases: Glaucoma, Ocular hypertension, orbitopathy (endocrine orbitopathy), ischemic / non-ischemic occlusion of blood vessels of the eye, indirect detection ICT carotid artery-cavernous fistula, amaurosis fugax, optic neuropathy. D-ODM is suitable for immediate evaluation of IKT, but is not suitable for continuous monitoring. As it can be repeated, it is useful for a patient suspected of having an increased ICT.Key words: central retinal artery, central retinal vein, colour Doppler ultrasonography, digital ophthalmodynamometry, intracranial pressure, pressure of cerebrospinal fluid, transcranial Doppler ultrasonography, intraocular pressure, venous pulsation pressure, venous outflow pressure, retinal venous pressure.
Topics: Glaucoma; Humans; Intracranial Pressure; Intraocular Pressure; Ophthalmodynamometry; Ophthalmologists; Ultrasonography, Doppler, Color
PubMed: 28931297
DOI: No ID Found -
Frontiers in Physiology 2019Carotid artery geometry influences blood flow disturbances and is thus an important risk factor for carotid atherosclerosis. Extracellular matrix (ECM) and...
OBJECTIVES
Carotid artery geometry influences blood flow disturbances and is thus an important risk factor for carotid atherosclerosis. Extracellular matrix (ECM) and yes-associated protein (YAP) expression may play essential roles in the pathophysiology of carotid artery stenosis, but the effect of blood flow disturbances of carotid bifurcation location on the ECM is unknown. We hypothesized that carotid artery anatomy and geometry are independently associated with the ECM and YAP expression.
METHODS
In this cross-sectional study, 193 patients were divided into two groups: an asymptomatic group ( = 111) and a symptomatic group ( = 82), symptomatic patients presenting with ischemic attack, amaurosis fugax, or minor non-disabling stroke. For all subjects before surgery, carotid bifurcation angle and internal artery angle were measured with computed tomography angiography (CTA), and laminar shear stress was measured with ultrasonography. After surgery, pathology of all plaque specimens was analyzed using hematoxylin and eosin (HE) staining and Movat special staining. Immunohistochemistry was performed to detect expression of YAP in a subset of 30 specimens.
RESULTS
Symptomatic patients had increased carotid bifurcation angle and laminar shear stress compared to asymptomatic patients ( < 0.05), although asymptomatic patients had increased internal carotid angle compared to symptomatic patients ( < 0.001). Relative higher bifurcation angles were correlated with increased carotid bifurcation, decreased internal angle, and decreased laminar shear stress. For each change in intervertebral space or one-third of vertebral body height, carotid bifurcation angle changed 4.76°, internal carotid angle changed 6.91°, and laminar shear stress changed 0.57 dynes/cm. Pathology showed that average fibrous cap thickness and average narrowest fibrous cap thickness were greater in asymptomatic patients than symptomatic patients ( < 0.05). Expression of proteoglycan and YAP protein in symptomatic patients was higher than in asymptomatic patients ( < 0.001), while collagen expression was lower in symptomatic patients than asymptomatic patients ( < 0.05).
CONCLUSION
Geometry of the carotid artery and position relative to cervical spine might be associated with ECM and YAP protein expression, which could contribute to carotid artery stenosis.
PubMed: 32038300
DOI: 10.3389/fphys.2019.01628 -
The British Journal of Ophthalmology Nov 1992Nine young adults (median age 19.5 years) who suffered from amaurosis fugax (AF) are described. The attacks of AF were short in duration and preceded by premonitory...
Nine young adults (median age 19.5 years) who suffered from amaurosis fugax (AF) are described. The attacks of AF were short in duration and preceded by premonitory symptoms in five cases and by a migrainous headache in two. In five patients the visual loss progressed in a lacunar pattern unlike the 'curtain' pattern characteristic of AF in older patients. Investigation revealed no evidence of an embolic or atheromatous aetiology. In two cases a minor abnormality was found on echocardiography. We conclude that AF in young adults has a different clinical pattern and may have a different aetiology, possibly migrainous, compared with that seen in older patients. The pattern of visual loss in some of the cases suggests that the choroidal circulation rather than the retinal circulation is primarily affected.
Topics: Adolescent; Adult; Blindness; Child; Female; Follow-Up Studies; Humans; Male; Migraine Disorders; Prospective Studies; Time Factors; Visual Fields
PubMed: 1477040
DOI: 10.1136/bjo.76.11.660 -
Journal of Vascular Surgery May 2021The current recommendations are to perform carotid endarterectomy within 2 weeks of symptoms for maximum long-term stroke prevention, although urgent carotid... (Comparative Study)
Comparative Study
OBJECTIVE
The current recommendations are to perform carotid endarterectomy within 2 weeks of symptoms for maximum long-term stroke prevention, although urgent carotid endarterectomy within 48 hours has been associated with increased perioperative stroke. With the development and rapid adoption of transcarotid artery revascularization (TCAR), we decided to study the effect of timing on the outcomes after TCAR.
METHODS
The Vascular Quality Initiative database was searched for symptomatic patients who had undergone TCAR from September 2016 to November 2019. These patients were stratified by the interval to TCAR after symptom onset: urgent, within 48 hours; early, 3 to 14 days; and late, >14 days. The primary outcome was the in-hospital rate of combined stroke and death (stroke/death), evaluated using logistic regression analysis. The secondary outcome was the 1-year rate of recurrent ipsilateral stroke and mortality, evaluated using Kaplan-Meier survival analysis.
RESULTS
A total of 2608 symptomatic patients who had undergone TCAR were included. The timing was urgent for 144 patients (5.52%), early for 928 patients (35.58%), and late for 1536 patients (58.90%). Patients undergoing urgent intervention had an increased risk of in-hospital stroke/death, which was driven primarily by an increased risk of stroke. No differences were seen for in-hospital death. On adjusted analysis, urgent intervention resulted in a threefold increased risk of stroke (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.3-6.2; P = .01) and a threefold increased risk of stroke/death (OR, 2.9; 95% CI, 1.3-6.4; P = .01) compared with late intervention. Patients undergoing early intervention had comparable risks of stroke (OR, 1.3; 95% CI, 0.7-2.3; P = .40) and stroke/death (OR, 1.2; 95% CI, 0.7-2.1; P = .48) compared with late intervention. On subset analysis, the type of presenting symptoms was an effect modifier. Patients presenting with stroke and those presenting with transient ischemic attack or amaurosis fugax both had an increased risk of stroke/death when undergoing urgent compared with late TCAR (OR, 2.7; 95% CI, 1.1-6.6; P = .04; and OR, 4.1; 95% CI, 1.1-15.0; P = .03, respectively). However only patients presenting with transient ischemic attack or amaurosis fugax had experienced an increased risk of stroke with urgent compared with late TCAR (OR, 5.0; 95% CI, 1.4-17.5; P < .01). At 1 year of follow-up, no differences were seen in the incidence of recurrent ipsilateral stroke (urgent, 0.7%; early, 0.2%; late, 0.1%; P = .13) or postdischarge mortality (urgent, 0.7%; early, 1.6%; late, 1.8%; P = .71).
CONCLUSIONS
We found that TCAR had a reduced incidence of stroke when performed 48 hours after symptom onset. Urgent TCAR within 48 hours of the onset of stroke was associated with a threefold increased risk of in-hospital stroke/death, with no added benefit for ≤1 year after intervention. Further studies are needed on long-term outcomes of TCAR stratified by the timing of the procedure.
Topics: Aged; Aged, 80 and over; Carotid Artery Diseases; Databases, Factual; Endovascular Procedures; Female; Hospital Mortality; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Retrospective Studies; Risk Assessment; Risk Factors; Stents; Stroke; Time Factors; Time-to-Treatment; Treatment Outcome
PubMed: 33038481
DOI: 10.1016/j.jvs.2020.08.148