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. December 1989. 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]</ref> | *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]</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*Patients report complete blackening of vision. | *Patients report complete blackening of vision. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
''Causes are divided into '''embolic''', '''hemodynamic''', '''ocular''', '''neurologic''', and '''idiopathic''' <ref> "Current management of amaurosis fugax. The Amaurosis Fugax Study Group". Stroke 21 (2): 201–8. February 1990. doi:10.1161/01.STR.21.2.201. PMID 2406992 [http://stroke.ahajournals.org/content/21/2/201.full.pdf Full Text]</ref> | ''Causes are divided into '''embolic''', '''hemodynamic''', '''ocular''', '''neurologic''', and '''idiopathic''' <ref> "Current management of amaurosis fugax. The Amaurosis Fugax Study Group". Stroke 21 (2): 201–8. February 1990. doi:10.1161/01.STR.21.2.201. PMID 2406992 [http://stroke.ahajournals.org/content/21/2/201.full.pdf Full Text]</ref> | ||
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**[[Central Retinal Vein Occlusion (CRVO)]] | **[[Central Retinal Vein Occlusion (CRVO)]] | ||
*Drug abuse-related intravascular emboli | *Drug abuse-related intravascular emboli | ||
===Hemodynamic=== | ===Vascular/Hemodynamic=== | ||
*[[Carotid stenosis]] | *[[Carotid stenosis]] | ||
*Arteritis ([[Temporal arteritis]], [[Takayasu arteritis]]) | *Arteritis ([[Temporal arteritis]], [[Takayasu arteritis]]) | ||
*Hypoperfusion ([[CHF]], [[Hyperviscosity syndrome]], | *Hypoperfusion ([[CHF]], [[Hyperviscosity syndrome]], hypercoagulable state)<ref>Bacigalupi M et al. "Amaurosis Fugax-A Clinical Review". The Internet Journal of Allied Health Sciences and Practice. 2006 4 (2): 1–6.[http://ijahsp.nova.edu/articles/vol4num2/Bacigalupi.pdf Fulltext]</ref><ref>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.</ref> | ||
===Ocular=== | ===Ocular=== | ||
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===Idiopathic=== | ===Idiopathic=== | ||
*Diagnosis of exclusion | *Diagnosis of exclusion | ||
==Evaluation== | ==Evaluation== | ||
''Workup will focus will vary significantly based on the differential and clinical presentation'' | ''Workup will focus will vary significantly based on the differential and clinical presentation'' | ||
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In general it includes: | In general it includes: | ||
*[[ECG]] | *[[ECG]] | ||
*CT | *[[CT brain]] non con and CTA head and neck | ||
* | *[[CXR]] | ||
*Basic Metabolic Panel | *Basic Metabolic Panel | ||
*CBC (to assess for severe anemia or thrombocytosis) | *CBC (to assess for severe anemia or thrombocytosis) | ||
*INR (if patient is | *INR (if patient is anticoagulated) | ||
*MRI (if suspicion for [[CVA]], [[Multiple Sclerosis]], or undifferentiated mass lesion) | *MRI (if suspicion for [[CVA]], [[Multiple Sclerosis]], or undifferentiated mass lesion) | ||
*Ocular ultrasound (evaluate for retinal detachment or hemorrhage) | *[[Ocular ultrasound]] (evaluate for retinal detachment or hemorrhage) | ||
==Management== | ==Management== | ||
''Management also varies also based final diagnosis'' | ''Management also varies also based final diagnosis'' | ||
*Intrinsic ocular causes require ophtho evaluation and referral | *Intrinsic ocular causes require ophtho evaluation and referral | ||
*Cardiologic cause requires | *Cardiologic cause requires admission and cardiology consultation | ||
*Neurologic causes require | *Neurologic causes require admission and neurologic consultation | ||
*Hematologic causes or | *Hematologic causes or vasculitis related causes will require sub specialist consultation | ||
==Disposition== | ==Disposition== | ||
Revision as of 14:09, 14 September 2019
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 mortality[2]
Clinical Features
- Patients report complete blackening of vision.
Differential Diagnosis
Causes are divided into embolic, hemodynamic, ocular, neurologic, and idiopathic [3]
Embolic
- Carotid emboli or Cardiac emboli in origin causing
- Drug abuse-related intravascular emboli
Vascular/Hemodynamic
- Carotid stenosis
- Arteritis (Temporal arteritis, Takayasu arteritis)
- Hypoperfusion (CHF, Hyperviscosity syndrome, hypercoagulable state)[4][5]
Ocular
- Ischemic optic neuropathy
- Nonvascular causes
- Retinal Detachment
- Vitreous hemorrhage
- Malignancy
Neurologic
- Migraine[6]
- Papilledema
- Optic neuritis
- Intracranial mass
- Intracranial hemorrhage
- Multiple Sclerosis
- Psychogenic
Idiopathic
- Diagnosis of exclusion
Evaluation
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
- CXR
- Basic Metabolic Panel
- CBC (to assess for severe anemia or thrombocytosis)
- INR (if patient is anticoagulated)
- 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 admission and cardiology consultation
- Neurologic causes require admission and neurologic consultation
- Hematologic causes or vasculitis related causes will require sub specialist consultation
Disposition
- Close follow-up or admission depending on the final determined cause
See Also
Acute Vision Loss (Noninflamed)
External Links
References
- ↑ 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
- ↑ 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 Full text
- ↑ "Current management of amaurosis fugax. The Amaurosis Fugax Study Group". Stroke 21 (2): 201–8. February 1990. doi:10.1161/01.STR.21.2.201. PMID 2406992 Full Text
- ↑ 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.