Amaurosis fugax

Neurology

Clinicals - History

Fact Explanation
Risk factors for stroke or ischemic heart disease. The patients presenting with amaurosis fugax (as follows) are almost predicted to have a stroke syndrome, ischemic heart disease and a high predicted mortality rate, since the statistical relationship between them is linked too closely as un-earthed by studies done over years. , , , The underlying reason for this is amaurosis is due to retinal vascular occlusion, which is one manifestation of various vascular occlusive disorders. Risk factors for stroke or ischemic heart disease.
The patients presenting with amaurosis fugax (as follows) are almost predicted to have a stroke syndrome, ischemic heart disease and a high predicted mortality rate, since the statistical relationship between them is linked too closely as un-earthed by studies done over years. , , , The underlying reason for this is amaurosis is due to retinal vascular occlusion, which is one manifestation of various vascular occlusive disorders.
Middle age man It's more common in middle age patients, or elderly patient and mostly prevalent in the male sex. But younger patients, below 40 years with amaurosis fugax have been studied. Middle age man
It's more common in middle age patients, or elderly patient and mostly prevalent in the male sex. But younger patients, below 40 years with amaurosis fugax have been studied.
Sudden loss of vision It's due to occlusion of one or more arteries that supplies the retinal bed and resultant ischemia. The retinal artery, ophthalmic artery and ciliary artery are end arteries, so blockage results in prompt ischemia. The causes can be divided as embolic, hemodynamic, ocular, neurologic, and idiopathic. But the commonest is atherosclerosis in the carotid artery and resultant thrombo-embolism. The visual loss can be unilateral or bilateral, and can last for seconds to minutes. The impairment progressively may involve the entire visual field. The loss of vision usually begins in the upper field, less frequently in the periphery, and rarely in the lower field. It also can be patchy or homogeneous. It can be repetitive, in those cases the patients may complain about having previous episodes. , , , , , , , Sudden loss of vision
It's due to occlusion of one or more arteries that supplies the retinal bed and resultant ischemia. The retinal artery, ophthalmic artery and ciliary artery are end arteries, so blockage results in prompt ischemia. The causes can be divided as embolic, hemodynamic, ocular, neurologic, and idiopathic. But the commonest is atherosclerosis in the carotid artery and resultant thrombo-embolism. The visual loss can be unilateral or bilateral, and can last for seconds to minutes. The impairment progressively may involve the entire visual field. The loss of vision usually begins in the upper field, less frequently in the periphery, and rarely in the lower field. It also can be patchy or homogeneous. It can be repetitive, in those cases the patients may complain about having previous episodes. , , , , , , ,

Clinicals - Examination

Fact Explanation
Complete eye examination The findings co-relate to the underlying conditions rather than amaurosis itself. The expected findings are retinal plaques, rubeosis iridis, neovascular glaucoma, venous stasis retinopathy, central and branch retinal artery occlusion, ischemic optic neuropathy, and asymmetric hypertensive retinopathy. Ocular signs of ischemia include occlusion of a branch retinal artery, regional retinal pallor, microinfarcts, and small hemorrhage. Distended, irregular veins and peripheral microaneurysms suggest retinal vascular insufficiency. Other than that, the ophthalmological findings are normal usually. , , , Complete eye examination
The findings co-relate to the underlying conditions rather than amaurosis itself. The expected findings are retinal plaques, rubeosis iridis, neovascular glaucoma, venous stasis retinopathy, central and branch retinal artery occlusion, ischemic optic neuropathy, and asymmetric hypertensive retinopathy. Ocular signs of ischemia include occlusion of a branch retinal artery, regional retinal pallor, microinfarcts, and small hemorrhage. Distended, irregular veins and peripheral microaneurysms suggest retinal vascular insufficiency. Other than that, the ophthalmological findings are normal usually. , , ,
Complete neurological examination Look for already present neurological deficits i.e. motor weakness, sensory weakness or cranial nerve weakness. , , Complete neurological examination
Look for already present neurological deficits i.e. motor weakness, sensory weakness or cranial nerve weakness. , ,
Complete cardiovascular examination To look for potential risk factors for or clues of cardiovascular disease. i.e. atherosclerosis, irregularly irregular pulse. , , , Complete cardiovascular examination
To look for potential risk factors for or clues of cardiovascular disease. i.e. atherosclerosis, irregularly irregular pulse. , , ,

Investigations - Diagnosis

Fact Explanation
Color Doppler studies of retinal vasculature To define the site of occlusion. , , Color Doppler studies of retinal vasculature
To define the site of occlusion. , ,
Angiography of carotid arteries Since carotid artery diseases are a major cause in amaurosis fugax, it's important to rule out any pathologies in the carotid arteries. , , , , Angiography of carotid arteries
Since carotid artery diseases are a major cause in amaurosis fugax, it's important to rule out any pathologies in the carotid arteries. , , , ,
Erythrocyte sedimentation rate To look for an inflammatory cause for occlusion. i.e. giant cell arteritis , Erythrocyte sedimentation rate
To look for an inflammatory cause for occlusion. i.e. giant cell arteritis ,
Oculoplethysmography Angiography has associated morbidity and mortality, so this is used to assess vasculature where angiography is undesired. , , Oculoplethysmography
Angiography has associated morbidity and mortality, so this is used to assess vasculature where angiography is undesired. , ,

Investigations - Management

Fact Explanation
Follow up for neurological syndromes i.e. stroke. Since the pathologies behind amaurosis fugax and vascular accidents are somewhat similar, it's necessary to follow up previous neurological incidents or screen out future risks (ref. investigations for fitness) i.e. lipid profiles, fasting blood sugar, serum electrolytes. , , , , Follow up for neurological syndromes
i.e. stroke. Since the pathologies behind amaurosis fugax and vascular accidents are somewhat similar, it's necessary to follow up previous neurological incidents or screen out future risks (ref. investigations for fitness) i.e. lipid profiles, fasting blood sugar, serum electrolytes. , , , ,
Complete blood count To exclude presence of an infection or anemia prior to surgery. Complete blood count
To exclude presence of an infection or anemia prior to surgery.
Liver function tests i.e. Serum transaminases, bilirubin, gamma-GT, albumin and total protein. To exclude liver disease prior to surgery. Liver function tests
i.e. Serum transaminases, bilirubin, gamma-GT, albumin and total protein. To exclude liver disease prior to surgery.
Renal function tests i.e. serum electrolytes, urine full report, serum creatinine. To exclude renal disorders prior to surgery. Renal function tests
i.e. serum electrolytes, urine full report, serum creatinine. To exclude renal disorders prior to surgery.
Chest X-ray To exclude respiratory illness prior to surgery. Chest X-ray
To exclude respiratory illness prior to surgery.
Fasting blood sugar To look for diabetes as a risk factor for embolism and to exclude it prior to surgery. Fasting blood sugar
To look for diabetes as a risk factor for embolism and to exclude it prior to surgery.
Lipid profile To look for dyslipidemia as a risk factor for embolism and to exclude lipid disorder prior to surgery. Lipid profile
To look for dyslipidemia as a risk factor for embolism and to exclude lipid disorder prior to surgery.
12 lead electrocardiogram To exclude presence of atrial fibrillations a causative factor for embolism. 12 lead electrocardiogram
To exclude presence of atrial fibrillations a causative factor for embolism.
Echocardiogram To exclude the presence of luminal thrombus. Echocardiogram
To exclude the presence of luminal thrombus.
Screening for the risk of stroke The investigations that are used to screen for stroke should be carried out. i.e. lipid profile, fasting blood glucose, serum electrolytes. , , , , Screening for the risk of stroke
The investigations that are used to screen for stroke should be carried out. i.e. lipid profile, fasting blood glucose, serum electrolytes. , , , ,

Management - Supportive

Fact Explanation
Remove risk factors for stroke Remove or reduce risk factors for cardiovascular and cerebrovascular diseases. Remove risk factors for stroke
Remove or reduce risk factors for cardiovascular and cerebrovascular diseases.
Patient education Education about the nature of the condition, risk for future vascular incidents, and the importance of removing the modifiable risk factors can improve the survival. Patient education
Education about the nature of the condition, risk for future vascular incidents, and the importance of removing the modifiable risk factors can improve the survival.

Management - Specific

Fact Explanation
Aspirin Adding low dose daily aspirin for stroke prevention has been proved to be useful. Aspirin
Adding low dose daily aspirin for stroke prevention has been proved to be useful.
Carotid endarterectomy Where embolization via carotid arteries have been proved the source of occlusion and in symptomatic patients. Carotid endarterectomy
Where embolization via carotid arteries have been proved the source of occlusion and in symptomatic patients.
Managing the co-morbidities. Since amaurosis is linked too closely with current or future vascular pathologies, it's important to manage them together to get the best outcome. Managing the co-morbidities.
Since amaurosis is linked too closely with current or future vascular pathologies, it's important to manage them together to get the best outcome.

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