Ignoring transient vision loss in right eye could have been risky for a 50-year old
1. 50-year old Mr Raj presented with symptoms of sudden onset loss of vision in right eye, which recovered in 30 minutes. It first occurred 30 days back and recurred a week back.
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1. 50-year old Mr Raj presented with symptoms of sudden onset loss of vision in right eye, which recovered in 30 minutes. It first occurred 30 days back and recurred a week back.
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2. As his #vision had completely recovered a month back, Raj ignored it and did not seek medical help. When it recurred for the second time, he decided to see an #ophthalmologist.
Eye check up was normal and he was referred to a #neurologist.
#neurotwitter
Eye check up was normal and he was referred to a #neurologist.
#neurotwitter
3. On enquiry, he had complete loss of vision in right eye on both the occasions, which lasted for 30 and 20 minutes respectively. He had no headache or any other neurological symptoms.
He was taking medicines for high BP for two years.
The diagnosis was clear by now.
He was taking medicines for high BP for two years.
The diagnosis was clear by now.
4. I asked for CAROTID DOPPLER test. Within two hours, Raj returned with the report. There was 80% stenosis in right carotid artery and 40% stenosis in left carotid artery.
The final diagnosis was transient monocular blindness (amaurosis fugax) due to carotid stenosis.
The final diagnosis was transient monocular blindness (amaurosis fugax) due to carotid stenosis.
5. Raj was at very high risk of getting #stroke and he could have been left paralyzed, if the atherosclerotic plaque in carotid artery had ruptured and travelled to brain, thereby blocking blood supply of brain.
I referred him for urgent carotid revascularization procedure.
I referred him for urgent carotid revascularization procedure.
6. The procedure was uneventful.
Blood thinner medicines and statins were continued, in addition to his BP-lowering drugs.
Blood thinner medicines and statins were continued, in addition to his BP-lowering drugs.
7. Take home message
*Short-duration loss of vision in one eye is often due to blockage of blood supply. Blood supply to eye comes from a branch of carotid artery, which supplies blood to brain also.
*Detailed evaluation including carotid doppler should be done in such cases.
*Short-duration loss of vision in one eye is often due to blockage of blood supply. Blood supply to eye comes from a branch of carotid artery, which supplies blood to brain also.
*Detailed evaluation including carotid doppler should be done in such cases.
8. Carotid stenosis is present in patients with ocular ischemia in 10% of those with transient visual loss.
Those with carotid stenosis have a higher risk of stroke recurrence and should be considered for urgent surgical intervention.
doi.org/10.1308/rcsann…
Those with carotid stenosis have a higher risk of stroke recurrence and should be considered for urgent surgical intervention.
doi.org/10.1308/rcsann…
9. The most common cause of transient blindness in one eye is athero-thrombo-embolism from the origin of the internal carotid artery. Antiplatelet therapy is needed for all, and carotid endarterectomy is needed if carotid stenosis is >70%.
doi.org/10.1080/106419…
doi.org/10.1080/106419…
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