Amaurosis fugax as the presenting manifestation of dural arteriovenous malformation.

Abstract

SUMMARY A 46-year-old woman under investigation for three episodes of amaurosis fugax in the left eye proved to have a left anterior-middle fossa dural arteriovenous malformation with pial venous drainage. The malformation received its main supply from the left middle meningeal artery, but its anterior part was fed by the recurrent meningeal branch of the left ophthalmic artery. Transient episodic lowering of retinal arterial pressure due to shunting of blood from the ophthalmic artery to the malformation is the most likely explanation for the occurrence of amaurosis fugax, indicating that this symptom occurs in some patients on a hemodynamic basis. Stroke Vol 16, No 5, 1985TRANSIENT ISCHEMIC ATTACKS rarely occur in relation to intracranial arteriovenous malformations (AVM's),' and among them transient monocular blindness (TMB) seems to be exceptional. 2 -3 We report a patient with recurrent episodes of isolated TMB as the presenting manifestation of a dural AVM. Patient ReportThe patient, a 46-year-old white housewife, was admitted to University Hospital on July 17, 1984.In 1979, she noted a continuous left frontal noise, without headache, which spontaneously resolved in a few minutes. One year before admission, she experienced transient monocular blindness in the left eye just after standing up from a chair, with no other associated symptoms. This loss of vision was characterized by a quick (2 seconds) centripetal darkening of vision to complete blindness; the eye maintained completely blind for 1 minute, followed by a progressive reappearance of the vision in the entire visual field within 30 seconds. Eight months later, while bending forward, the patient suffered a similar episode of transient monocular blindness in the left eye of slightly longer duration (5 minutes). Two months later, a similar event recurred while she was sitting in a boat, and lasted at least 15 minutes, but the patient experienced the loss of vision only in the lower half-field of the left eye, in an ascending curtain-like fashion. A few weeks later, she became aware of transient recurrence of the noise in the left forehead. A CT scan and a carotid angiogram were performed revealing two dural AVM's of the From the Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.•Supported by grants from the Swiss Academy of Medical Sciences and the S1CPA Foundation.Address correspondence to: Dr. F. Vinuela, Department of Diagnostic Radiology, University Hospital, P.O. Box 5339, London, Ontario, Canada N6A-5A5.Received November 19, 1984; revision #1 accepted January 24, 1985. anterior-middle fossa: a larger one in the region of the pterion on the left and a smaller one in the area of the insertion of the falx anteriorly. She was referred to this institution for treatment.On physical examination, the patient was alert and cooperative. Blood pressure ws 120/70 mm.Hg. and cardiac auscultation was normal. No bruits were heard on the supraclavicular fossa, neck, eyes or head. Optic fundi were normal, wi...

Benign Recurrent Transient Monocular Blindness: A Possible Variant of Acephalgic Migraine

“…"fog"; from bottom up 11 "everything grays out" 12 "blotchy vision"; total loss, resolves slowly 13 "suddenly goes black" 14 "sudden loss of vision" 15 "went completely out of focus" 16 "like a shutter"; altitudinal loss, upper half 17 "whitish oblong shape"; moves up; obscures vision 18 central island of vision preserved 19 "vision blurs then completely blacks out"; aura of lights 20…”

A Case of Posterior Ischemic Optic Neuropathy in a Posterior-draining Dural Cavernous Sinus Fistula

“…Gillilan (7) found it in 75% of 20 specimens and Hayreh and Dass (8) in 2.2% of 170 specimens. Bogousslavsky (9) reported a patient with amaurosis fugax resulting from a middle fossa dural arteriovenous malformation partially fed by the recurrent meningeal branch of the ophthalmic artery. He speculated that episodic lowering of ophthalmic artery/retinal arterial blood pressure might be responsible for the amaurosis fugax.…”

Partial Steal Phenomenon in the Ophthalmic Artery Due to a Direct Carotid-Cavernous Sinus Fistula

“…11,12 Similar to carotid occlusive disease, a few cases with flow reversal in the OA due to a dural arteriovenous fistula or arteriovenous malformation have been reported and defined as the "ophthalmic steal phenomenon." [5][6][7] In our patient, the waveform pattern in distal branches of the left OA was abnormal in the Doppler spectrum. The arterial flow during systole and early diastole was reversed, whereas the flow during late diastole at the end of the cardiac cycle was forward transiently.…”

“…4 Although the relevant literature reveals limited information about a steal phenomenon in ophthalmic arteries (OAs) of patients with dural arteriovenous fistulas, to our knowledge, the partial steal phenomenon in the OA has not been described. [5][6][7] In this report, we describe color Doppler imaging findings and give a physiologic explanation of the partial steal phenomenon in the OA of a patient with a direct CCF.…”