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Approach to “Visual Loss”
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Aastha Takkar Kapila, Monika Singla, Vivek Lal
Interruption of vascular flow is the commonest cause of transient monocular blindness (amaurosis fugax). Determining the etiology of TMVL will guide the management. Vital information regarding onset, progression, duration, triggers, associated symptoms and field defects improves the yield of diagnosis. A simple approach to a patient with transient visual loss is given in Algorithm 4.1.
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
TA is an inflammatory process of the medium sized vessels, particularly vessels arising from the proximal aorta. It rarely affects the intracranial vessels. The condition often presents with fever, malaise and weight loss. Headache occurs in most people (around two thirds). There may be temporal artery tenderness or reduced palpable pulsation. Other symptoms can include jaw claudication (50% of cases), scalp tenderness (50%) and visual symptoms (20%). Possible visual symptoms include amaurosis fugax and diplopia.71 Permanent, painless visual loss, due to involvement of the retinal vessels, can occur after several days without treatment. Examination may reveal papilloedema and retinal haemorrhages. The condition presents as pyrexia of unknown origin in around 15% of people. Serum ESR is usually > 50 mm/hour. A temporal artery biopsy (ideally before steroids, but may be positive up to two weeks after their commencement) may reveal a characteristic pattern of vasculitis (e.g. monocyte infiltration and granuloma formation). The artery may only show segmental involvement, so a 2 cm length sample is required. Alternatively, ultrasound of the artery can be used to aid diagnosis. Treatment is with steroids (typically prednisolone at a dose of 40 to 60 mg per day). The dose can gradually be reduced over several months.
Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
With a transient ischemic attack, the neurologic deficits resemble those of strokes. Amaurosis fugax is transient blindness in one eye. This usually lasts for less than 5 minutes, and can occur if the ophthalmic artery is damaged by the TIA. Symptoms of TIAs begin quickly. They commonly last between 2 and 30 minutes and then completely resolve. It is possible for an individual to have several TIAs per day, or to have just 2–3 TIAs over several years.
A giant left atrial myxoma causing mitral valve pseudostenosis – a mimicker
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Basel Abdelazeem, Hafiz Khan, Hameem Changezi, Ahmad Munir
A 47-year-old female presented with worsening exertional dyspnea, malaise, and unintentional weight loss of 10 Ibs for six weeks. The patient was able to perform regular activities with no prior physical limitations; however, at the time of presentation, climbing one flight of stairs resulted in severe shortness of breath. The patient denied any fever, chills, night sweating, cough, chest pain, dizziness, syncope, intermittent claudication, or amaurosis fugax. The patient reported smoking one pack per year for 25 years with no other past medical or cardiac illness. The clinical examination revealed a heart rate of 112 beats per minute, blood pressure of 121/84 mmHg, and temperature of 98.1°F. The patient was hypoxic with oxygen saturation of 84% on room air and required 2 L oxygen with a nasal cannula to maintain saturations above 92%. The rest of the physical examination was pertinent for regular S1, S2, apical diastolic rumbling murmur, raised jugular venous distension, bilateral basal crackles and wheezes in lungs, and bilateral 2+ pedal edema.
The role of biologics in the treatment of giant cell arteritis
Published in Expert Opinion on Biological Therapy, 2019
Miguel A. González-Gay, Trinitario Pina, Diana Prieto-Peña, Mónica Calderon-Goercke, Ricardo Blanco, Santos Castañeda
Typical cranial symptoms include an abrupt onset of headache, scalp tenderness, jaw claudication or more rarely tongue claudication, dry cough, or sore throat due to arteritis involvement of branches derived of the external carotid artery [2,6]. GCA patients may suffer visual manifestations, such as amaurosis fugax or permanent visual loss, which are generally due to involvement of the posterior ciliary arteries that are branches of the internal carotid artery [7]. Patients with GCA have an increased risk of developing aneurysms and dissection over the course of the disease, especially in the thoracic segment of the aorta [8,9]. In a recent study, structural damage in the aorta affected up to 33.3% of individuals after long term follow-up [10]. Once aortic structural damage occurs, dilatation increases over time, underlining the need for periodic evaluation [10].
Transient vision loss: a neuro-ophthalmic approach to localizing the diagnosis
Published in Expert Review of Ophthalmology, 2018
Helen Chung, Jodie M. Burton, Fiona E. Costello
Rather than representing a specific diagnosis, gaze evoked amaurosis describes a clinical sign attributable to extrinsic compression on the optic nerve or retinal blood supply when a patient moves his or her eyes in a particular direction [34]. The majority (82%) of gaze-evoked amaurosis cases are due to intraconal pathology, most commonly optic nerve sheath meningiomas and cavernous hemangiomas [34]. Occasionally, intraorbital foreign bodies can also be associated with gaze-evoked nystagmus [34]. Extraconal processes, such as orbital wall factures and idiopathic intracranial hypertension, have been reported to cause this phenomenon [2,34]. As patients may not recognize vision loss in extremes of gaze, it has been recommended that assessment for gaze-evoked amaurosis be done in all patients presenting with an orbital process. Clinically, this can be accomplished by having the patient hold an eccentric gaze position for at least 5 s (in all directions), and then documenting any manifestations of TVL or pupil changes during these maneuvers [34].