Amaurosis fugax: Difference between revisions
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==Background== | ==Background== | ||
*Transient painless visual loss caused by either circulatory, ocular or a neurologic condition. Vision loss can last a few seconds to minutes.<ref>Fisher CM et al. "'Transient monocular blindness' versus 'amaurosis fugax'". Neurology 39 (12): 1622–4. doi:10.1212/wnl.39.12.1622. PMID 2685658</ref> | *Transient painless visual loss caused by either circulatory, ocular or a neurologic condition. Vision loss can last a few seconds to minutes.<ref>Fisher CM et al. "'Transient monocular blindness' versus 'amaurosis fugax'". Neurology. December 1989. 39 (12): 1622–4. doi:10.1212/wnl.39.12.1622. PMID 2685658</ref> | ||
*Fugax is greek for "fleeing" | *Fugax is greek for "fleeing" | ||
*Greatest suspicion in assessing these patients should be to evaluation for acute stroke and embolic phenomenon as that will carry the greatest mortality<ref>Benavente O et al. "Prognosis after transient monocular blindness associated with carotid-artery stenosis". N. Engl. J. Med. 345 (15): 1084–90. doi:10.1056/NEJMoa002994. PMID 11596587 [http://www.nejm.org/doi/pdf/10.1056/NEJMoa002994 Full text] | *Greatest suspicion in assessing these patients should be to evaluation for acute stroke and embolic phenomenon as that will carry the greatest mortality<ref>Benavente O et al. "Prognosis after transient monocular blindness associated with carotid-artery stenosis". N. Engl. J. Med. 345 (15): 1084–90. doi:10.1056/NEJMoa002994. PMID 11596587 [http://www.nejm.org/doi/pdf/10.1056/NEJMoa002994 Full text] | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 15:44, 18 February 2015
Background
- Transient painless visual loss caused by either circulatory, ocular or a neurologic condition. Vision loss can last a few seconds to minutes.[1]
- Fugax is greek for "fleeing"
- Greatest suspicion in assessing these patients should be to evaluation for acute stroke and embolic phenomenon as that will carry the greatest mortalityCite error: Closing
</ref>missing for<ref>tag
Embolic
- Carotid emboli or Cardiac emboli in origin causing
- Drug abuse-related intravascular emboli
Hemodynamic
- Carotid stenosis
- Arteritis (Temporal arteritis, Takayasu's arteritis)
- Hypoperfusion (CHF, Hyperviscosity syndrome, hyper coagulable state)[2][3]
Ocular
- Ischemic optic neuropathy
- Nonvascular causes
- Retinal Detachment
- Vitreous hemorrhage
- Malignancy
Neurologic
- Migraine[4]
- Papilledema
- Optic neuritis
- Intracranial mass
- Intracranial hemorrhage
- Multiple sclerosis
- Psychogenic
Idiopathic
- Diagnosis of exclusion
Workup
Workup will focus will vary significantly based on the differential and clinical presentation
In general it includes:
- ECG
- CT Brain non con and CTA head and neck
- Chest Xray
- Basic Metabolic Panel
- CBC (to assess for severe anemia or thrombocytosis)
- INR (if patient is anticogulated)
- MRI (if suspicion for CVA, Multiple sclerosis, or undifferentiated mass lesion)
- Ocular ultrasound (evaluate for retinal detachment or hemorrhage)
Management
management also varies also based final diagnosis
- Intrinsic ocular causes require ophtho evaluation and referral
- Cardiologic cause requires medicine admission and cardiology consultation
- Neurologic causes require medicine admission and neurologic consultation
- Hematologic causes or vasculatisis related causes will require medicine evaluation and sub specialist consultation
Disposition
- Close followup or admission depending on the final determined cause
See Also
Acute_Vision_Loss_(Noninflamed)
External Links
Sources
- ↑ Fisher CM et al. "'Transient monocular blindness' versus 'amaurosis fugax'". Neurology. December 1989. 39 (12): 1622–4. doi:10.1212/wnl.39.12.1622. PMID 2685658
- ↑ Bacigalupi M et al. "Amaurosis Fugax-A Clinical Review". The Internet Journal of Allied Health Sciences and Practice. 2006 4 (2): 1–6.Fulltext
- ↑ Mundall J, Quintero P, Von Kaulla KN, Harmon R, Austin J (March 1972). "Transient monocular blindness and increased platelet aggregability treated with aspirin. A case report". Neurology 22 (3): 280–5.
- ↑ Mattsson, P, Lundberg, PO. Characteristics and prevalence of transient visual disturbances indicative of migraine visual aura. Cephalalgia. Jun 1999;19(5):477.