Amaurosis fugax

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

Hemodynamic

Ocular

Neurologic

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
  • 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 follow-up or admission depending on the final determined cause

See Also

Acute Vision Loss (Noninflamed)

External Links

References

  1. 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
  2. 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
  3. "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
  4. Bacigalupi M et al. "Amaurosis Fugax-A Clinical Review". The Internet Journal of Allied Health Sciences and Practice. 2006 4 (2): 1–6.Fulltext
  5. 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.
  6. Mattsson, P, Lundberg, PO. Characteristics and prevalence of transient visual disturbances indicative of migraine visual aura. Cephalalgia. Jun 1999;19(5):477.