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Amaurosis fugax
From WikEM
Contents
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
Hemodynamic
- Carotid stenosis
- Arteritis (Temporal arteritis, Takayasu arteritis)
- Hypoperfusion (CHF, Hyperviscosity syndrome, hyper coagulable 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
- 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
- ↑ 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.
