Ischemic Optic Neuropathy Associated With Internal Carotid Artery Dissection

Abstract

Ischemic optic neuropathy may occur as an early sign of carotid dissection: young age, previous transient monocular blindness, an association with pain, Horner syndrome, or hemispheric transient ischemic attacks are suggestive of this cause and should prompt confirmatory investigations.

Spontaneous cervical artery dissection: an update on clinical and diagnostic aspects

“…Brief and recurrent monocular visual loss episodes and ischemic optic neuropathy are assumed to be mainly due to hypoperfusion than due to embolism 39 . Patients with ICA dissection and ischemic events present significant higher prevalences of stenoses and occlusions and significant lower prevalences of horner syndrome and lower cranial nerves palsy (symptoms more frequent in subadventitial dissection) than patients with no ischemic events 34 .…”

The ophthalmology of internal carotid artery dissection

“…As Biousse et al (1998) pointed out, ischemic optic neuropathy in association with ICA dissection differs clinically from other causes of nonarteritic ION: the patients are younger (this was not the case in our patient), and they have severe pain. It could be difficult to distinguish it from AION in older patients, but the absence of systemic symptoms and normal sedimentation rate can be helpful.…”

“…One of our patients had ischemic optic neuropathy (ION), combined with Horner's syndrome. Only ten cases are previously published with ION due to ICA dissection (Mokri et al1996, Bogousslavsky et al 1987, McNeill et al 1980, Newman et al 1989, Rivkin et al 1990, Tsai & Sun 1997, Biousse et al 1998). Four patients are described as having anterior ischemic optic neuropathy with optic disc swelling, and four other with posterior optic neuropathy, without detectable optic disc changes.…”

Ceguera secundaria a neuropatía óptica isquémica por una disección carotídea espontánea: Caso clínico

“…Es debido a una disminución del flujo sanguíneo en las pequeñas arterias que lo nutren, derivadas de la arteria central de la retina y la arteria oftálmica que son ramas terminales de la arteria carótida interna. Se caracteriza clínicamente por una pérdida súbita, generalmente indolora de la visión monocular, con defecto pupilar aferente y un déficit visual monocular 5 . El fondo de ojo revela una papila hiperémica con hemorragias peripapilares cuando se afecta la parte anterior del nervio (neuropatía óptica isquémica anterior) como en nuestro caso, pero es normal si se afecta la parte retrobulbar.…”

“…Es infrecuente el compromiso de otros pares craneales destacando el compromiso del duodécimo par o hipogloso. Aún más inusual, no existen más de 8 casos descritos en la literatura [2][3][4][5] , es la presentación como amaurosis secundaria a neuropatía óptica isquémica (NOI) o por infarto de la arteria central retina debido a embolización a arteria oftálmica proveniente de la disección carotídea. Presentamos un paciente que debuta con un cuadro agudo de ceguera monocular y cuyo estudio confirma la presencia de una disección carotídea ipsilateral.…”