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Douglas VP, Rachapudi SS, Davila-Siliezar P, Laylani NAR, Lee AG. Transient Monocular Visual Loss ( Amaurosis Fugax): How Does Age Impact Diagnosis? Ophthalmol Ther 2024:10.1007/s40123-024-00932-z. [PMID: 38587773 DOI: 10.1007/s40123-024-00932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Transient monocular visual loss (TMVL), also known as transient monocular blindness or amaurosis fugax ("fleeting blindness"), is a temporary loss of vision often due to ischemia to the retina. While acute TMVL should be considered an emergency that further requires exhaustive investigation, there are some cases in which TMVL arises secondary to benign causes. Age has a major impact in the diagnosis of ischemia and although the differential diagnosis of TMVL can be broad, timely and appropriate history, examination, diagnostic testing, and treatment can be vision- or life-saving. We review the causes of TMVL and the impact of age on the differential diagnoses and management.
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Affiliation(s)
| | - Sruti S Rachapudi
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
| | - Pamela Davila-Siliezar
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA
| | - Noor A R Laylani
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA
| | - Andrew G Lee
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA.
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA.
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Texas A and M College of Medicine, Bryan, TX, USA.
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Martinez-Viguera A, Xuclà-Ferrarons T, Collet R, Olmedo-Saura G, Martí-Fàbregas J, Izquierdo A, Martínez-Domeño A, Prats-Sánchez L, Guasch-Jiménez M, Guisado-Alonso D, Ramos-Pachón A, Camps-Renom P. Clinical characteristics and outcome of amaurosis fugax due to transient retinal ischemia: Results from a contemporary cohort. J Stroke Cerebrovasc Dis 2023; 32:107335. [PMID: 37748428 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Whether presenting an episode of amaurosis fugax (AFx) increases the risk of ischemic stroke is controversial and there is a lack of consensus in the following management. We aimed to describe the clinical characteristics and prognosis of patients with AFx due to suspected transient retinal ischemia. METHODS Observational, retrospective study of patients admitted in a Comprehensive Stroke Center with diagnosis of AFx due to suspected transient retinal ischemia between 2015 and 2020. Clinical characteristics and diagnostic-therapeutic data were collected, as well as recurrences (new episodes of amaurosis and/or ischemic strokes). Multivariable Cox regression analyses were performed to study factors associated with the risk of recurrence. RESULTS We included 91 patients with a mean age of 67.9±14.8 years, 43(47.3%) were women. After the diagnostic workup 14(15.4%) AFx were attributed to an atherothrombotic etiology, 4(4.4%) cardioembolic source, 10(11%) other determined cause (TOAST-OC) and 63(69,2%) indeterminate etiology. 71(78%) patients started antiplatelet therapy and 2(2.2%) anticoagulant therapy. After a median follow-up of 3.5 years (IQR 1.8-5.2), at least one recurrence was recorded in eight (8.8%) patients (four new AFx and four cerebral infarctions). TOAST-OC (HR=9.66, 95% CI 2.41-38.70; p=0.001) and prior history of ischemic stroke (HR=4.21. 95% CI 1.01-17.66; p=0.049) were both independently associated with the risk of recurrence. CONCLUSIONS In two out of three patients, AFx due to transient retinal ischemia was of undetermined cause. The risk of stroke recurrence after a first episode of AFx in our cohort was 8.8%. Patients with TOAST-OC etiology identified were at highest risk of recurrence.
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Affiliation(s)
- Ana Martinez-Viguera
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret 167, Barcelona 08025, Spain.
| | - Tomàs Xuclà-Ferrarons
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - Roger Collet
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - Gonzalo Olmedo-Saura
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Artur Izquierdo
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Luis Prats-Sánchez
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Marina Guasch-Jiménez
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Daniel Guisado-Alonso
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Anna Ramos-Pachón
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
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Bayardo-Gutiérrez B, Yamazaki-Nakashimada MA, Rodríguez-Lozano AL, Gómez-Garza G, Rivas-Larrauri FE, Gutiérrez-Hernández JA, Scheffler-Mendoza SC. Amaurosis as an initial presentation of Takayasu arteritis in children. Rheumatol Int 2023; 43:575-87. [PMID: 35366089 DOI: 10.1007/s00296-022-05115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Visual disturbances in Takayasu arteritis (TA) are common but tend to be late manifestations of the disease. However, its presence at diagnosis must alert TA to avoid sight disabilities. Herein, we present two children with TA that debuted with vision loss, and the results of the literature review displayed 58 subjects with vision loss before the diagnosis of TA. The world English literature was reviewed by searching the PubMed database of the National Library of Medicine for the terms "Takayasu Arteritis" and "Blindness" or "Amaurosis fugax", from 190 to 2021. Cases eligible must present vision loss before or at TA diagnosis. Our two patients who presented with amaurosis fulfilled the criteria for TA diagnosis. The first patient had a bilateral and transient visual loss, whereas the second had monocular and permanent amaurosis. Both patients were cursed with hypertension and demonstrated large vessel compromise; their clinical picture improved with corticosteroids and immunosuppressant therapy. We identified in the literature review sixteen patients with TA in case reports and 42 in case series, plus our two cases presented herein with monocular or bilateral vision loss at the time of diagnosis. Previous literature indicated that amaurosis represents a severely advanced disease. Herein, we reported two children with amaurosis as their pivotal symptom; they had significant head and neck vascular alterations, so prompt and aggressive treatment is needed to prevent disease progression and disability. Transient or permanent vision loss must alert the physician to include Takayasu arteritis in the differential diagnosis.
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Deutsche Ophthalmologische Gesellschaft (DOG), Retinologische Gesellschaft e. V. (RG), Berufsverband der Augenärzte Deutschlands e. V. (BVA). [Retinal arterial occlusions (RAV) : S2e guidelines of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 7 October 2022]. Ophthalmologie 2023; 120:15-29. [PMID: 36525048 DOI: 10.1007/s00347-022-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
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Riese N, Smart Y, Bailey M. Asymptomatic retinal emboli and current practice guidelines: a review. Clin Exp Optom 2023; 106:4-9. [PMID: 35109784 DOI: 10.1080/08164622.2022.2033600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Asymptomatic retinal emboli are found in 1-3% of patients on routine fundus examination. As the use of teleretinal imaging for diabetic patients and ocular photography continues to increase, the number of asymptomatic retinal emboli found will also increase. This article will discuss the different aetiologies of retinal emboli and will present an overview of the recommended referrals for further systemic testing and treatment. It is important to communicate well with the primary care physician when asymptomatic retinal emboli are detected to ensure the appropriate investigations are undertaken.
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Affiliation(s)
- Nicole Riese
- Department of Optometry, VA New Jersey Healthcare System, Brick, NJ, USA
| | - Yelena Smart
- Department of Optometry, VA New Jersey Healthcare System, Brick, NJ, USA
| | - Melissa Bailey
- Department of Neurology, University of Miami, Miami, FL, USA
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Cunha LP, Atalla Â, de Melo Costa-Neto J, Costa-Cunha LVF, Preti RC, Zacharias LC, Monteiro MLR. Multiple attacks of transient monocular visual loss in a previously healthy man: a possible complication after COVID-19 vaccination? Int J Retina Vitreous 2022; 8:43. [PMID: 35725633 PMCID: PMC9207875 DOI: 10.1186/s40942-022-00393-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background The present case aims to describe a previously healthy man who presented multiple attacks of transient monocular visual loss after Pfizer-BioNTech COVID-19 vaccination and to discuss the possible mechanisms related to occurrence of this condition. Case presentation We report a case of multiple attacks of transient monocular visual loss in a previously healthy middle-aged man two weeks after Pfizer-BioNTech COVID-19 vaccination. TVL attacks were described as sudden and painless complete visual loss, lasting about one minute, followed by a full recovery. He presented several non-simultaneous attacks in both eyes, 16 in the right eye, and 2 in the left eye on the same day, fifteen days after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine. The brain’s magnetic resonance angiography, echocardiogram, and doppler ultrasound imaging of the carotid and vertebral arteries were non-revealing. The complete blood exam revealed a slightly elevated C-reactive protein test. We assessed fundus examination during the transient visual loss attack and revealed diffuse vascular narrowing for both arterial and venous branches, notably in the emergence of the optic disc in right eye. In addition, the circumpapillary optical coherence tomography angiography (OCTA) vessel density map was reduced. Oral verapamil hydrochloride 60 mg twice daily was initiated, and the attacks of transient visual loss improved after two days. Conclusions To date, and the best of our knowledge, this is the first case report of multiple transient monocular visual loss attacks due to retinal vasospasm in a previously healthy middle-aged man documented by fundus retinography and OCTA. We discuss in this article the possible association of retinal vasospasm and Pfizer-BioNTech COVID-19 vaccination, probably related to vaccine-induced inflammation.
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Affiliation(s)
- Leonardo Provetti Cunha
- Department of Ophthalmology, Federal University of Juiz de Fora Medical School, Juiz de Fora, MG, Brazil. .,Department of Hematology, Federal University of Juiz de Fora Medical School, Juiz de Fora, MG, Brazil. .,Juiz de Fora Eye Hospital, Av. Rio Branco, 4051, Bom Pastor, Juiz de Fora, MG, 36021-660, Brazil.
| | - Ângelo Atalla
- Department of Hematology, Federal University of Juiz de Fora Medical School, Juiz de Fora, MG, Brazil
| | - José de Melo Costa-Neto
- Juiz de Fora Eye Hospital, Av. Rio Branco, 4051, Bom Pastor, Juiz de Fora, MG, 36021-660, Brazil
| | | | - Rony Carlos Preti
- Department of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
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Kalloniatis M, Wang H, Katalinic P, Ly A, Apel W, Nivison-Smith L, Kalloniatis KF. Ocular ischaemia: signs, symptoms, and clinical considerations for primary eye care practitioners. Clin Exp Optom 2022; 105:117-134. [PMID: 34982952 DOI: 10.1080/08164622.2021.1999771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Ischaemic stroke is a major disease burden as well as a leading cause of death. Early signs of ischaemic stroke can manifest in the eye, placing primary eyecare practitioners in an important position to identify patients at risk of ischaemic stroke and initiate suitable referral pathways. The vascular supply to the brain is reviewed with reference to vision including the various retinal signs and ocular symptoms associated with transient ischaemic attacks and ischaemic stroke. Using a range of clinical cases, the diverse clinical presentations of retinal embolic events, as well as other forms of vascular occlusion, are highlighted and the underlying pathophysiology is discussed. A succinct scheme for the assessment and management of ischaemic events for primary eye care practitioners is provided.
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Affiliation(s)
- Michael Kalloniatis
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Henrietta Wang
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Paula Katalinic
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Warren Apel
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,The Eye Health Centre, Aspley, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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8
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Noiri JI, Konishi H, Matsuzoe H, Sato S, Azami T, Teramura K. Giant thrombus in the left atrium after radiofrequency catheter ablation for atrial fibrillation: A case report. HeartRhythm Case Rep 2021; 7:773-5. [PMID: 34820278 DOI: 10.1016/j.hrcr.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Kubo K, Kimura N, Watanabe R, Higashino M, Tsuda M, Kato M. Oxaliplatin-Associated Amaurosis Fugax. Case Rep Oncol 2021; 14:832-837. [PMID: 34248547 PMCID: PMC8255733 DOI: 10.1159/000516271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Kimitoshi Kubo
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Noriko Kimura
- Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Ryosuke Watanabe
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Masayuki Higashino
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Momoko Tsuda
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
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10
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Hokazono K, Carstens LD, Ribeiro Monteiro ML. Contractile peripapillary staphyloma: OCTA documentation of increased peripapillary vessel density during transient visual loss episodes. Am J Ophthalmol Case Rep 2021; 21:101010. [PMID: 33532661 PMCID: PMC7823202 DOI: 10.1016/j.ajoc.2021.101010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/26/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose to describe a patient with a contractile peripapillary staphyloma and transient visual loss (TVL) that underwent repeated OCTA examination documenting disc contraction and increased peripapillary vessel density as the mechanism of TVL. Observations a 28-year-old male presented multiple daily episodes of TVL for the last 5 years. Fundoscopic examination revealed a peripapillary staphyloma. The fundus photographs and SS-OCT demonstrated flattening of the posterior polo and crowding of the contracted optic disk, which became hyperemic with tortuous and dilated veins during visual loss episodes. OCTA showed temporary increased peripapillary vessel density, presumably from severe venous congestion leading to TVL during the contraction. Conclusion and Importance increased peripapillary vessel density can be demonstrated by OCTA during TVL in contractile peripapillary staphyloma. These findings indicate that severe venous stasis during disc contraction is the cause of TVL.
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Affiliation(s)
- Kenzo Hokazono
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
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Cheng SF, Zarkali A, Richards T, Simister R, Chandratheva A. Carotid artery stenosis, an underestimated cause of stroke recurrence in patients with ischaemic monocular visual loss. Ann R Coll Surg Engl 2019; 101:579-583. [PMID: 31155910 DOI: 10.1308/rcsann.2019.0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Isolated monocular ischaemic events are thought to be low risk for stroke recurrence. In the presence of carotid stenosis however, the risks should not be treated similarly and surgical intervention should be considered at an early stage. The aim of this study was to determine the vascular risk profile and stroke recurrence in patients with ischaemic monocular visual loss. METHODS AND METHODS Consecutive records for all patients with monocular ischaemia were reviewed from January 2014 to October 2016. Stroke, transient ischaemic attack or monocular ischaemia recurrence within 90 days were recorded. Carotid stenosis was assessed with duplex ultrasound, computed tomography or magnetic resonance angiography. RESULTS In total, 400 patients presented with monocular ischaemia; 391 had carotid imaging (97.8%). Causality was symptomatic carotid stenosis ≥ 50% in 53 (13.6%), including carotid stenosis ≥ 70% in 31 (7.9%). Patients with permanent visual loss (n = 131) were more likely to have significant stenosis compared with patients with transient visual loss (n = 260), 19.8% compared with 10.4% (P = 0.012). Recurrent stroke, transient ischaemic attack or monocular ischaemia within 90 days after presentation occurred in three patients (5.7%) in the carotid stenosis group, compared to three (0.9%) who did not have stenosis (P = 0.035). Age, male sex and hypertension were associated with carotid stenosis but hypercholesterolaemia, diabetes and smoking were not. CONCLUSIONS Carotid stenosis ≥ 50% is present in patients with ocular ischaemia in approximately 20% of those with persistent visual loss and in 10% with transient visual loss. Those with carotid stenosis have a higher risk of stroke recurrence and should be considered urgent surgical intervention as other forms of stroke.
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Affiliation(s)
- S F Cheng
- Department of Vascular Surgery, University College Hospital NHS Trust, London, UK.,Division of Surgery and Interventional Science, University College London, UK
| | - A Zarkali
- Department of Stroke, University College Hospital NHS Trust, London, UK
| | - T Richards
- Department of Vascular Surgery, University College Hospital NHS Trust, London, UK.,Division of Surgery and Interventional Science, University College London, UK
| | - R Simister
- Department of Stroke, University College Hospital NHS Trust, London, UK
| | - A Chandratheva
- Department of Stroke, University College Hospital NHS Trust, London, UK
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Kandiyil N, MacSweeney ST, Heptinstall S, May J, Fox SC, Auer DP. Circulating Microparticles in Patients with Symptomatic Carotid Disease Are Related to Embolic Plaque Activity and Recent Cerebral Ischaemia. Cerebrovasc Dis Extra 2019; 9:9-18. [PMID: 30943521 PMCID: PMC6489022 DOI: 10.1159/000495942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/03/2018] [Indexed: 01/19/2023] Open
Abstract
Background and Purpose In order to assess the association of microparticles derived from activated platelets (PMP) or endothelial cells (EMP) with risk markers for recurrent embolic events in patients with symptomatic carotid artery disease, we studied the associations between PMP/EMP and three risk markers: plaque haemorrhage (PH), micro-embolic signals and cerebral diffusion abnormalities. Methods Patients with recently symptomatic high-grade carotid artery stenosis (60–99%, 42 patients, 31 men; mean age 75 ± 8 years) and 30 healthy volunteers (HV, 11 men; mean age 56 ± 12 years) were prospectively recruited. Patients were characterised by carotid magnetic resonance imaging (presence of PH [MRI PH]), brain diffusion MRI (cerebral ischaemia [DWI+]) and transcranial Doppler ultrasound (micro-embolic signals [MES+]). PMP and EMP were classified by flow cytometry and expressed as log-transformed counts per microlitre. Results MES+ patients (n = 18) had elevated PMP (MES+ 9.61 ± 0.57) compared to HV (8.80 ± 0.73; p < 0.0001) and to MES– patients (8.55 ± 0.85; p < 0.0001). Stroke patients had elevated PMP (9.49 ± 0.64) and EMP (6.13 ± 1.0) compared to non-stroke patients (PMP 8.81 ± 0.73, p = 0.026, EMP 5.52 ± 0.65, p = 0.011) and HV (PMP 8.80 ± 0.73, p = 0.007, and EMP 5.44 ± 0.47, p = 0.006). DWI+ patients (n = 16) showed elevated PMP (DWI+ 9.53 ± 0.64; vs. HV, p = 0.002) and EMP (DWI+ 5.91 ± 0.99 vs. HV 5.44 ± 0.47; p = 0.037). Only PMP but not EMP were higher in DWI+ versus DWI– patients (8.67 ± 0.90; p = 0.002). No association was found between PMP and EMP with MRI PH. Conclusion PMP and EMP were associated with stroke and recent cerebrovascular events (DWI+) but only PMP were also associated with ongoing (MES+) thrombo-embolic activity suggesting a differential biomarker potential for EMP to index cerebral ischaemia while PMP may predict on-going thrombo-embolic activity.
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Affiliation(s)
- Neghal Kandiyil
- Radiological Sciences in the Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom, .,University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, United Kingdom,
| | - Shane T MacSweeney
- Vascular Surgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Stan Heptinstall
- Cardiovascular Medicine, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - Jane May
- Cardiovascular Medicine, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - Susan C Fox
- Cardiovascular Medicine, Division of Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
| | - Dorothee P Auer
- Radiological Sciences in the Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom.,NIHR Nottingham BRC, Nottingham, United Kingdom
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Alcalde-López J, Zapata-Arriaza E, Cayuela A, Moniche F, Escudero-Martínez I, Ortega-Quintanilla J, de Torres-Chacón R, Montaner J, Mayol A, González A. Safety of Early Carotid Artery Stenting for Symptomatic Stenosis in Daily Practice. Eur J Vasc Endovasc Surg 2018; 56:776-782. [PMID: 30177414 DOI: 10.1016/j.ejvs.2018.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE/BACKGROUND In 2006, the American Heart Association recommended that for preference carotid endarterectomy (CEA) or, alternatively, carotid angioplasty and stenting (CAS) for symptomatic carotid artery stenosis should ideally occur within 14 days of an ischaemic event. The aim was to determine the safety of CAS according to those recommendations in daily practice. METHODS A retrospective analysis was performed of all consecutive patients (2000-16), with ipsilateral carotid symptoms who underwent CAS for extracranial carotid stenosis ≥70%, who were previously included in a prospective database. Thirty day morbidity was assessed (any stroke without transient ischaemic attack [TIA]/amaurosis fugax), along with mortality of the procedure in the early (≤14 days after stroke onset) and delayed phases (15-180 days after stroke onset). Patients who received CAS and/or mechanical thrombectomy for acute ischaemic stroke treatment were not included. RESULTS In total, 1227 patients with symptomatic carotid stenosis who underwent CAS were identified. Early and delayed CAS was performed in 291 and 936 patients, respectively. Morbidity (any stroke) and mortality was 2.2% (n = 27) in the whole cohort (n = 8 [2.7%] in early vs. n = 19 [2%] in delayed CAS; p = .47). There were no differences in morbidity between early and delayed CAS regarding TIA (n = 15 vs. 36 [5.2% vs. 3.9%]; p = .33), minor stroke (n = 4 vs. 5 [1.4% vs. 0.5%]; p = .14), or major stroke (n = 2 vs. 6 [0.7% vs. 0.6%]; p = .59). Two patients (0.7%) died after early CAS and eight (0.9%) after delayed CAS (p = .56). CONCLUSION CAS may be safely performed in the early phase after an ischaemic stroke with low clinical complication rates. Further studies are needed to validate CAS safety conducted even earlier in the acute phase of ischaemic stroke.
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Affiliation(s)
- Jesús Alcalde-López
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Elena Zapata-Arriaza
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Aurelio Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | - Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Joaquín Ortega-Quintanilla
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Head of Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Antonio Mayol
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alejandro González
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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Tran KD, Read SP, Patel NA, Flynn HW, Schatz NJ. Antiphosphospholipid syndrome presenting with amaurosis fugax and cotton wool spots. Am J Ophthalmol Case Rep 2017; 7:143-145. [PMID: 29260101 PMCID: PMC5722133 DOI: 10.1016/j.ajoc.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/28/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose To describe the importance of considering vaso-occlusive disease on the differential diagnosis of a patient presenting with amaurosis fugax (AF) and unilateral cotton wool spots (CWS). Observations A 69-year-old female with history of obesity, hyperlipidemia and recent orthopedic surgery, presented with 3 days of worsening monocular AF and CWS in the right eye. She was diagnosed with antiphosphospholipid syndrome based on positive serologic testing for antiphosphatidylserine IgM, anticardiolipin IgM. The patient was treated with lipid lowering medication, long-term aspirin, and has followed a weightloss and physical therapy program under medical supervision. The CWS resolved and AF symptoms have not recurred. Conclusions and importance Antiphospholipid syndrome can be considered in the differential diagnosis of patients presenting with AF, assymetric CWS, and/or rapid progression of symptoms.
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Affiliation(s)
- Kimberly D Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sarah P Read
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Norman J Schatz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
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15
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Morán-Sánchez JC, Gómez-Estévez I, El Berdei Y, Gómez-Sánchez JC, Ramos-Araque ME. Double or nothing: red flag symptoms of critical carotid stenosis, a case report. BMC Neurol 2017; 17:69. [PMID: 28381256 PMCID: PMC5382405 DOI: 10.1186/s12883-017-0849-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 03/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background Detailed knowledge of every possible manifestation of Internal Carotid Artery (ICA) disease is important. For improving detection and a timely adoption of secondary prevention procedures or treatments. Transient oculomotor nerve palsies have been described associated with stenosis or occlusion of the ICA. Case presentation We described a patient that develop a sequential combination of transient monocular loss of vision followed by binocular diplopia secondary to an unstable atherosclerotic preocclusive stenosis of an internal carotid artery previously treated with radiotherapy. Conclusions The peculiar sequence of transient monocular vision that give rise later into a transient binocular diplopia (double or nothing) should be kept in mind as a possible manifestation of critical stenosis of ICA.
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Affiliation(s)
- José Carlos Morán-Sánchez
- Department of Neurology, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | - Irene Gómez-Estévez
- Department of Neurology, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | - Yasmina El Berdei
- Department of Neurology, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain.,Institute of Biomedical Research of Salamanca, University Hospital of Salamanca, Salamanca, Spain
| | - José C Gómez-Sánchez
- Department of Neurology, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain.,Institute of Biomedical Research of Salamanca, University Hospital of Salamanca, Salamanca, Spain
| | - María E Ramos-Araque
- Department of Neurology, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain. .,Institute of Biomedical Research of Salamanca, University Hospital of Salamanca, Salamanca, Spain.
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16
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Volkers EJ, Donders RC, Koudstaal PJ, van Gijn J, Algra A, Jaap Kappelle L. Transient monocular blindness and the risk of vascular complications according to subtype: a prospective cohort study. J Neurol 2016; 263:1771-7. [PMID: 27314958 DOI: 10.1007/s00415-016-8189-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 11/02/2022]
Abstract
Patients with transient monocular blindness (TMB) can present with many different symptoms, and diagnosis is usually based on the history alone. In this study, we assessed the risk of vascular complications according to different characteristics of TMB. We prospectively studied 341 consecutive patients with TMB. All patients were interviewed by a single investigator with a standardized questionnaire; reported symptoms were classified into predefined categories. We performed Cox regression analyses with adjustment for baseline vascular risk factors. During a mean follow-up of 4.0 years, the primary outcome event of vascular death, stroke, myocardial infarction, or retinal infarction occurred in 60 patients (annual incidence 4.4 %, 95 % confidence interval (CI) 3.4-5.7). An ipsilateral ischemic stroke occurred in 14 patients; an ipsilateral retinal infarct in six. Characteristics of TMB independently associated with subsequent vascular events were: involvement of only the peripheral part of the visual field (hazard ratio (HR) 6.5, 95 % CI 3.0-14.1), constricting onset of loss of vision (HR 3.5, 95 % CI 1.0-12.1), downward onset of loss of vision (HR 1.9, 95 % CI 1.0-3.5), upward resolution of loss of vision (HR 2.0, 95 % CI 1.0-4.0), and the occurrence of more than three attacks (HR 1.7, 95 % CI 1.0-2.9). We could not identify characteristics of TMB that predicted a low risk of vascular complications. In conclusion, careful recording the features of the attack in patients with TMB can provide important information about the risk of future vascular events.
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Shim DH, Cha JK, Kang MJ, Choi JH, Nah HW. Vasospastic Amaurosis Fugax Diagnosed by Cerebral Angiography. J Stroke Cerebrovasc Dis 2015; 24:e323-5. [PMID: 26283520 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/02/2015] [Accepted: 07/16/2015] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED We report a case of recurrent monocular blindness presumed to be caused by vasospasm, demonstrated by digital subtraction angiography. CASE REPORT A 65-year-old man presented with recurrent visual loss in the left eye for 2 years. He had histories of hypertension, cigarette smoking, and May-Thurner syndrome. The symptom occurred variably from twice a day to once a week and usually lasted for 5 minutes. Brain magnetic resonance imaging, magnetic resonance angiography, and ophthalmologic evaluation did not reveal any abnormality. Cerebral digital subtraction angiography was performed. On the left internal carotid angiogram, vasospasm occurred in the cervical portion of the left internal carotid artery and, subsequently, the blood flow to the left ophthalmic artery diminished. This phenomenon was reproducible and, in the absence of vasospasm, the ophthalmic artery was well visualized with no steno-occlusive lesion. Examination of the carotid duplex showed diffuse luminal narrowing and increased flow velocities in the left cervical internal carotid artery without atherosclerotic plaque. Treatment was started with nimodipine, which markedly reduced the attacks. CONCLUSION We assumed that vasomotor instability, which made the vessels vulnerable to spasm, may have caused a recurrent ocular symptom in our patient.
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Kalita J, Kumar P, Misra UK. Cervical rib resulting in amaurosis fugax and stroke. Clin Neurol Neurosurg 2013; 115:2388-9. [PMID: 24035686 DOI: 10.1016/j.clineuro.2013.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/25/2013] [Accepted: 08/18/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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