EpistemisAmaurosis fugax
Specialty: Ophthalmology.
Why it occurs
- Stenosis of the internal carotid artery due to embolic atheroma plaque
- Vertebrobasilar or orbital microvasculature insufficiency
- Transient spasm of the central retinal artery
- Giant cell arteritis (temporal arteritis)
- Hypercoagulability states or hyperviscosity syndromes
- Embolism of cardiac origin (due to atrial fibrillation or valvular heart disease)
Initial workup
Doppler ultrasound of the carotid arteries and supra-aortic vessels to rule out significant foci of stenosis; Electrocardiogram (ECG) and 24-hour Holter monitoring to rule out emboligenic arrhythmias; Urgent analysis of acute phase reactants (Erythrocyte Sedimentation Rate - ESR, and C Reactive Protein - CRP); Angio-CT or Angio-MR of cerebral vessels and orbits; Temporal artery biopsy if giant cell vasculitis is suspected.
red flags
Sudden and transient loss of vision in one eye, which is accompanied by jaw claudication when chewing, persistent temporary unilateral headache, hypersensitivity to touch on the scalp and diffuse pain in the shoulder or pelvic girdle (urgent suspicion of giant cell arteritis, with imminent risk of permanent bilateral visual loss).
Standard management
- Acetylsalicylic acid — 100 mg orally daily as an antiplatelet agent indicated for the secondary prevention of carotid atherothrombotic events
- Methylprednisolone — intravenous bolus 250 mg to 1 g daily for 3 days if temporal arteritis is clinically suspected to protect contralateral vision before obtaining biopsy results
- Prednisone (orally, continuing immunosuppressive therapy at a dose of 1 mg/kg/day with a slow decrease regimen guided by systemic inflammatory parameters).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Ophthalmology
- Listed causes
- 6
- Treatment options
- 3