Amaurosis Fugax: A Clinical Comparison

Abstract

Amaurosis Fugax: A Clinical Comparison• Amaurosis fugax (transient monocular blindness) is a symptom of retinal ischemia just as contralateral hemiparesis and sensory loss are symptoms of cerebral ischemia. These symptoms are produced by atherosclerotic stenosis of the carotid vessels at the ipsilateral carotid bifurcation and emboli from these areas causing focal, repetitive, retinal ischemia.A study of 31 endarterectomy patients was undertaken to see if eight patients with amaurosis fugax (25%) could be differentiated from 22 patients with transient cerebral ischemia. The patients with amaurosis fugax were found to be younger. They all had 75% or greater stenosis of the internal carotid artery at the bifurcation on the symptomatic side. They all had unilateral visual symptoms and these symptoms were relieved by surgery. The patients with amaurosis fugax were devoid of cardiac disease, while 45% of the cerebral ischemic patients had documented myocardial disease.Amaurosis fugax (transient monocular blindness) in the setting of clinically significant atheroslerosis of the carotid vessels is an indication for carotid endarterectomy.

Clinical and arteriographic comparison of amaurosis fugax with hemispheric transient ischemic attacks.

“…Our results differ markedly from those of Slepyan et al 1 who found a difference in average age of 5 years between the two groups (8 patients with amaurosis fugax and 23 with transient ischemic attacks). Their patients with amaurosis fugax had no evidence of cardiac disease; 60% of our patients with amaurosis fugax had confirmed myocardial infarction or congestive heart failure.…”

“…Both reflect transient ischemic processes secondary to stenoses or embolization from ulcerated plaques of the carotid arteries. Slepyan et al 1 suggested that the contrasts are significant between patients with amaurosis fugax and those with hemispheric transient ischemic attacks with respect to age, cardiac status, and angiographic findings and that on the basis of these factors patients of one group can be discriminated from the other. Because the number of patients they studied was small, we undertook a review of a larger series to determine if any important clinical as well as angiographic differences exist between these groups.…”

Arteriographic comparison of amaurosis fugax and hemispheric transient ischaemic attacks.

“…Ramirez-Lassepas et al 1 noted that angiograms were normal in only 4% of their cases of amaurosis fugax but in 27% of those with hemispheric TIAs. Slepyan et al 6 similarly found carotid disease more common, and cardiac disease rare in cases of amaurosis fugax when compared with TIA patients but their numbers were small. By contrast, Eisenberg and Mani 2 found comparable angiographic abnormalities in 40 patients with amaurosis fugax and 47 with TIAs.…”

Occurrence of Hemispheric and Retinal Ischemia in Atrial Fibrillation Compared With Carotid Stenosis

“…18 -20 That tighter stenosis in patients with carotid disease favors retinal as opposed to brain ischemia has been previously reported. [21][22][23][24][25] In fact, considering the degree of stenosis as it relates to the distribution of the index events supports these reports. Table 3 shows H:R odds of index or qualifying events in symptomatic vessels of 3:1 (331:97) versus 2:1 (219:112) for 50% to 69% and 70% to 99% stenosis, respectively (Pϭ0.001).…”