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Acta Ophthalmologica Scandinavica Feb 1999The aim of the study is to determine blood flow and resistance parameters (Resistance Index-RI, Pulsatility Index-PI) in the retrobulbar arteries of patients suffering... (Comparative Study)
Comparative Study
PURPOSE
The aim of the study is to determine blood flow and resistance parameters (Resistance Index-RI, Pulsatility Index-PI) in the retrobulbar arteries of patients suffering from amaurosis fugax.
METHODS
Color Doppler velocity was used to measure blood flow velocity and vascular resistance in the ophthalmic artery, central retinal artery and lateral short posterior ciliary artery of 32 involved eyes in their afflictless interval. The patients' mean age was 60.1 years (range 29-85). The age- and sexmatched control group comprised 32 healthy volunteers (32 eyes).
RESULTS
There was no significant difference neither in RI nor in PI of amaurosis fugax patients compared to the control group.
CONCLUSIONS
We conclude that in almost all cases of amaurosis fugax no local disturbance of blood flow in the afflictless interval is noted. However, increased vessel resistance is noticed in some cases of amaurosis fugax: Giant cell arteritis, intraorbital vascular anomalies, intraorbital tumors. In these cases color Doppler velocity is able to give information on the extent of blood flow disorder and, in particular by the B-mode, the etiology can be assumed.
Topics: Adult; Aged; Aged, 80 and over; Arteriosclerosis; Blindness; Blood Flow Velocity; Ciliary Arteries; Female; Giant Cell Arteritis; Humans; Male; Middle Aged; Ophthalmic Artery; Orbit; Retinal Artery; Ultrasonography, Doppler, Color; Vascular Resistance
PubMed: 10071141
DOI: 10.1034/j.1600-0420.1999.770104.x -
Cureus Aug 2023In this case report, we highlight a case of a 24-year-old primigravida who suffered a sudden and painless loss of vision and headache in the immediate postpartum period....
In this case report, we highlight a case of a 24-year-old primigravida who suffered a sudden and painless loss of vision and headache in the immediate postpartum period. Vision loss was transient and remarkable. Her brain magnetic resonance imaging revealed vasogenic edema in parieto-occipital white matter, suggestive of posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome is a clinical-radiological entity, having hemodynamic catastrophe also known as reversible posterior cerebral edema syndrome. It tends to occur during pregnancy complicated by eclampsia. Hypertension and a hypercoagulable tendency tend to engulf the entire homeostasis into its deadly clutches sending the autoregulation into a frizzy. It presents with a gamut of red flags like headache, seizures, encephalopathy, amaurosis fugax, cortical visual disturbances, and even blindness. Clinical improvement was seen with supportive treatment in this patient. Thus, timely diagnosis and intervention help reverse the dire consequences.
PubMed: 37727199
DOI: 10.7759/cureus.43703 -
Neuro-ophthalmology (Aeolus Press) 2013Mucormycosis is a rare and often fatal opportunistic angioinvasive infection seen mostly in immunocompromised patients, such as those with diabetes mellitus, cancer, or...
Mucormycosis is a rare and often fatal opportunistic angioinvasive infection seen mostly in immunocompromised patients, such as those with diabetes mellitus, cancer, or renal failure. Ophthalmic manifestations of orbital mucormycosis include ocular pain, periocular oedema, visual loss, ophthalmoplegia, proptosis, and ptosis. Although therapy for orbital mucormycosis consists of maximally tolerated doses of antifungal agents (e.g., amphotericin B) and extensive surgical debridement, treatment remains ineffective in up to 20% of cases. We describe two patients with rhino-orbitalmucormycosis who were successfully treated with posaconazole in conjunction with intravenous (IV) amphotericin B and sinus surgical debridement. These cases highlight several unusual early manifestations of orbital mucormycosis, including disc oedema and amaurosis fugax, as well as the applicability of a new extended-spectrum antifungal agent in management of orbital zygomycosis.
PubMed: 28167988
DOI: 10.3109/01658107.2013.809463 -
Journal of Neurology, Neurosurgery, and... Aug 2001
Topics: Adult; Amaurosis Fugax; Female; Humans; Takayasu Arteritis; Vertigo
PubMed: 11459913
DOI: 10.1136/jnnp.71.2.276 -
International Angiology : a Journal of... Aug 2021The risk of ischemic stroke in patients with chronic total occlusion (CTO) of the internal carotid artery (ICA) on best medical treatment has been estimated to be 5.5%...
BACKGROUND
The risk of ischemic stroke in patients with chronic total occlusion (CTO) of the internal carotid artery (ICA) on best medical treatment has been estimated to be 5.5% per year. The purpose of this study was to assess early and mid-term outcome of patients who underwent an attempt at transfemoral carotid artery stenting (CAS) for CTO of the ICA.
METHODS
Clinical data of symptomatic patients who underwent attempt at CAS for CTO of the ICA between January 1, 2010 and July 1, 2020 were retrospectively reviewed. Clinical success, perioperative and mid-term stroke and death rates were recorded. Descriptive statistics were used.
RESULTS
There were 27 patients, 14 females, 13 males, with a mean age of 66.8 years, range: 57 to 79. All patients had symptoms within 6 months prior to the procedure. 16 had ipsilateral stroke at a mean of 2.8 months, ranges: 1.5-4 months, two had transient ischemic attack (TIA), at 1 week and at 6 months, one had amaurosis fugax at one week, two had chronic ocular ischemia and six had chronic cerebral hypoperfusion. Technical success was 52% (14/27). One patient developed a minor reversible stroke (1/27, 3.7%) there was no early death, for an overall 30-day stroke and death rate of 3.7% (1/27). Two patients had perioperative TIAs. Among 14 patients with successful CAS (group A) one had minor, reversible ipsilateral stroke during a follow-up of 29 months (range: 4-112), two had contralateral stroke. There was no death. One patient developed asymptomatic stent occlusion, three had asymptomatic in-stent restenosis >50%, two had reinterventions. Among patients with unsuccessful attempt at CAS (group B), 31% (4/13) had stroke at 4, 10, 14 and 22 months, respectively. One stroke patient died at 10 months.
CONCLUSIONS
Transfemoral CAS of symptomatic patients with CTO of the ICA was feasible in half of the patients, with no mortality or major stroke, for an overall early stroke/death rate of 3.7%. Since one third of the patients with unsuccessful stenting developed stroke during follow-up, further studies to investigate the safety, efficacy and durability of CAS for CTO of the ICA are needed.
Topics: Aged; Carotid Artery, Internal; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Retrospective Studies; Stents; Stroke; Treatment Outcome
PubMed: 34528772
DOI: 10.23736/S0392-9590.21.04662-9 -
Journal of Vascular Surgery Oct 2020Transfemoral carotid artery stenting (CAS) has been validated as an acceptable alternative to carotid endarterectomy in patients at high risk for open surgery. There are... (Comparative Study)
Comparative Study
OBJECTIVE
Transfemoral carotid artery stenting (CAS) has been validated as an acceptable alternative to carotid endarterectomy in patients at high risk for open surgery. There are variable sex- and age-based differences in transfemoral CAS outcomes of published randomized controlled trials. The aim of our study was to evaluate sex-based differences in perioperative outcomes after transfemoral CAS performed in octogenarians.
METHODS
The National Surgical Quality Improvement Program targeted vascular module was queried for all patients ≥80 years of age who underwent transfemoral CAS between 2011 and 2017. Symptomatic status was defined as a history of prior ipsilateral stroke, transient ischemic attack, or amaurosis fugax. The primary outcome was a composite outcome of perioperative (30-day) stroke or death. Outcomes were compared for male vs female patients and stratified by symptomatic status using univariate and multivariable logistic regression analyses adjusting for emergent status, symptomatic status, comorbidities, and use of an embolic protection device.
RESULTS
Overall, there were 143 patients ≥80 years of age who underwent transfemoral CAS during the study period, including 95 men (66.4%) and 48 women (33.6%). Race (white, 88.0% vs 85.4%), symptomatic status (30.9% vs 29.2%), and degree of stenosis (severe, 71.6% vs 62.5%) were not significantly different for men vs women (P ≥ .27). Periprocedural stroke/death occurred in six men (6.4%) vs two women (4.2%; P = .59) and did not significantly differ when stratified according to symptomatic (6.9% vs 7.1%; P = .98) and asymptomatic (6.2% vs 2.9%; P = .49) status. Based on multivariable analysis, independent factors associated with the composite end point included emergent vs elective status (adjusted odds ratio OR [aOR], 20.3; 95% confidence interval [CI], 2.25-183) and failure to use an embolic protection device (aOR, 2.86; 95% CI, 1.59-50.0). Sex was not significantly associated with the primary outcome after risk adjustment (aOR, 0.81; 95% CI, 0.28-3.28).
CONCLUSIONS
We found no sex-based differences in risk of perioperative stroke/death among patients ≥80 years of age undergoing transfemoral CAS. Our study validates previous studies showing a high rate of perioperative complications after transfemoral CAS in octogenarians and suggests that the decision to use this technology in older patients should be determined by patients' anatomic and medical risk factors irrespective of sex.
Topics: Aged, 80 and over; Carotid Arteries; Carotid Stenosis; Endovascular Procedures; Female; Femoral Artery; Hospital Mortality; Humans; Male; Postoperative Complications; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Stents; Stroke; Treatment Outcome
PubMed: 32107096
DOI: 10.1016/j.jvs.2019.12.034 -
Journal of Nuclear Medicine : Official... May 2017Ga-labeled somatostatin receptor ligand PET imaging has recently been shown in preclinical and early human studies to have a potential role in the evaluation of...
Ga-labeled somatostatin receptor ligand PET imaging has recently been shown in preclinical and early human studies to have a potential role in the evaluation of vulnerable arterial plaques. We prospectively evaluated carotid plaque Ga-DOTATATE uptake in patients with recent carotid events, assessed inter- and intraobserver variability of such measurements, and explored the mechanism of any plaque DOTATATE activity with immunohistochemistry in resected specimens. Twenty consecutively consenting patients with recent symptomatic carotid events (transient ischemic attack, stroke, or amaurosis fugax), due for carotid endarterectomy, were prospectively recruited. Ga-DOTATATE PET/CT of the neck was performed before surgery. Ga-DOTATATE uptake was measured by drawing regions of interest along the carotid plaques and contralateral plaques/carotid arteries by an experienced radionuclide radiologist and radiographer. Two PET quantification methods with inter- and intraobserver variability were assessed. Resected carotid plaques were retrieved for somatostatin receptor subtype-2 (sst2) immunohistochemical staining. The median time delay between research PET and surgery was 2 d. SUVs and target-to-background ratios for the symptomatic plaques and the asymptomatic contralateral carotid arteries/plaques showed no significant difference ( = 19, > 0.10), regardless of quantification method. The intraclass correlation coefficient was greater than 0.8 in all measures of carotid artery/plaque uptake (SUV) and greater than 0.6 in almost all measures of target-to-background ratio. None of the excised plaques was shown to contain cells (macrophages, lymphocytes, vessel-associated cells) expressing sst2 on their cell membrane. Ga-DOTATATE activity on PET in recently symptomatic carotid plaques is not significantly different from contralateral carotids/plaques. Any activity seen on PET is not shown to be from specific sst2 receptor-mediated uptake in vitro. It is therefore unlikely that sst2 PET/CT imaging will have a role in the detection and characterization of symptomatic carotid plaques.
Topics: Aged; Carotid Stenosis; Female; Humans; Image Interpretation, Computer-Assisted; Male; Molecular Imaging; Observer Variation; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Receptors, Somatostatin; Reproducibility of Results; Sensitivity and Specificity; Tissue Distribution
PubMed: 27932558
DOI: 10.2967/jnumed.116.181438 -
Journal of Vascular Surgery Apr 2003Nonoperative treatment of recent internal carotid artery (ICA) occlusion is associated with increased recurrent stroke rates. We analyzed our results of carotid...
PURPOSE
Nonoperative treatment of recent internal carotid artery (ICA) occlusion is associated with increased recurrent stroke rates. We analyzed our results of carotid endarterectomy (CEA) for treatment of symptomatic recent ICA occlusion to evaluate its feasibility, safety, and outcomes.
METHODS
From 1990 to 2002, all patients with transient ischemic attack (TIA), amaurosis fugax, and minor stroke underwent duplex ultrasound (US) scanning and arteriography to confirm the diagnosis of ICA occlusion. Within 2 weeks of symptom onset, patients underwent operative exploration with attempted CEA. ICA occlusion was detected at preoperative angiography and confirmed at surgery. Patients with extensive ICA plaque not amenable to endarterectomy underwent external CEA with ICA ligation.
RESULTS
Over 12 years, 87 patients with symptomatic ICA occlusion underwent 90 operations for ICA exploration. In 30 patients (18 men, 12 women) with TIA (45%), amaurosis fugax (19%), or minor stroke (36%), CEA to treat ICA occlusion was technically successful. There was 1 postoperative stroke, 2 asymptomatic internal carotid occlusions, and no restenoses (mean follow-up, 26 months; range, 1-93 months). In 57 patients (37 men, 20 women) with TIA (41%), amaurosis fugax (27%), or stroke (32%) in whom CEA was unsuccessful, external CEA was performed. In this group there were no postoperative strokes, 2 asymptomatic external carotid artery occlusions, and 1 restenosis (>70%) (mean follow-up, 22 months; range, 1-73 months). There were no late strokes in either group.
CONCLUSION
Operative exploration and endarterectomy to treat symptomatic ICA occlusion is feasible and safe. Patients with symptomatic ICA occlusion should be considered candidates for CEA.
Topics: Adult; Aged; Aged, 80 and over; Angiography; Carotid Artery, Internal; Carotid Stenosis; Cerebrovascular Disorders; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Survival Analysis; Treatment Outcome; Ultrasonography, Doppler, Color
PubMed: 12663978
DOI: 10.1067/mva.2003.203 -
The Israel Medical Association Journal... Jun 2015
Topics: Aged; Amaurosis Fugax; Ciliary Arteries; Female; Giant Cell Arteritis; Humans; Optic Neuropathy, Ischemic; Retinal Artery Occlusion; Vision Disorders
PubMed: 26234004
DOI: No ID Found -
Stroke Nov 2020Research suggests that women and men may present with different transient ischemic attack (TIA) and stroke symptoms. We aimed to explore symptoms and features associated...
BACKGROUND AND PURPOSE
Research suggests that women and men may present with different transient ischemic attack (TIA) and stroke symptoms. We aimed to explore symptoms and features associated with a definite TIA/stroke diagnosis and whether those associations differed by sex.
METHODS
We completed a retrospective cohort study of patients referred to The Ottawa Hospital Stroke Prevention Clinic in 2015. Exploratory multinomial logistic regression was used to evaluate candidate variables associated with diagnosis and patient sex. Backwards elimination of the interaction terms with a significance level for staying in the model of 0.25 was used to arrive at a more parsimonious model.
RESULTS
Based on 1770 complete patient records, sex-specific differences were noted in TIA/stroke diagnosis based on features such as duration of event, suddenness of symptom onset, unilateral sensory loss, and pain.
CONCLUSIONS
This preliminary work identified sex-specific differences in the final diagnosis of TIA/stroke based on common presenting symptoms/features. More research is needed to understand if there are biases or sex-based differences in TIA/stroke manifestations and diagnosis.
Topics: Aged; Aged, 80 and over; Amaurosis Fugax; Aphasia; Carotid Stenosis; Cohort Studies; Dysarthria; Female; Hemianopsia; Humans; Ischemic Attack, Transient; Male; Middle Aged; Pain; Paresis; Retrospective Studies; Sex Factors; Smoking; Somatosensory Disorders; Time Factors
PubMed: 32993462
DOI: 10.1161/STROKEAHA.120.031510