Amaurosis fugax: Is it innocuous?
- 7 Downloads
A 10 year retrospective study of 103 patients with amaurosis fugax was done. Sixty-two patients with symptoms of amaurosis fugax underwent arteriography, which demonstrated ulcerated carotid plaque in 36 and hemodynamically significant stenoses (>75% diameter reduction) in 26. These 62 patients underwent carotid endarterectomy. The other 41 patients who had proven ulcerated plaque (33 patients) or hemodynamic stenoses (eight patients) were not treated surgically and served as a control series. No strokes or deaths occurred in the immediate postoperative period. Follow-up of the 62 operated patients extending to 10 years (mean 4.2 years), revealed one (1.6%) patient with recurrent amaurosis fugax symptoms, two (3.2%) with transient ischemic attacks, and one (1.6%) with a stroke in the operated hemisphere. In the nonoperated group, despite aspirin or warfarin treatment, four (9.7%) patients had ongoing amaurosis fugax symptoms, and two (4.8%) developed transient ischemic attacks that led to carotid endarterectomy. One (2.4%) other patient developed sudden, permanent monocular blindness, and two (4.8%) suffered hemispheric strokes, one of which was fatal. The cumulative morbidity (ongoing ocular or transient ischemic attack symptoms, perioperative and late stroke) in the operated group was 6.4% (four patients), while the cumulative morbidity in the nonoperated group was significantly higher at 21.9% (nine patients) (p=0.02). When patients present with symptoms of amaurosis fugax and have demonstrable carotid bifurcation disease, carotid endarterectomy is recommended. Amaurosis fugax should be regarded as a harbinger of monocular blindness and stroke.
Key wordsAmaurosis fugax carotid endarterectomy stroke carotid artery lesions blindness
Unable to display preview. Download preview PDF.
- 1.FISHER CM. Occlusion of the internal carotid artery.Arch Neurol Psych 1951;65:346–377.Google Scholar
- 2.VIRCHOW R. Zur Pathologis chen Anatomie der Neutchaut and des Sehnerven.Arch Pathol Anat Physiol Khn Med 1856;10:170.Google Scholar
- 3.FISHER CM. Transient monocular blindness associated with hemiplegia.AMA Arch Ophthal 1952;47:167–203.Google Scholar
- 7.MORAX PV, AVON RD, GAUTIER JC. Symptoms et signes opthalmologioques des stenoses et occlusions carotidiennes.Bull Serv Ophthalmol Française 1970;Suppl 1:169–172.Google Scholar
- 12.The Amaurosis Fugax Group. Current management of amaurosis fugax.Stroke 1990;21:201–208.Google Scholar
- 14.Canadian Cooperative Study Group. A randomized trial of aspirin and sulfinpyrazone in threatened stroke.N Engl J Med 1978;299:53–59.Google Scholar
- 16.Antiplatelet Trialists Collective Observation. Secondary prevention of vascular disease by prolonged antiplatelet therapy.Br Med J 1988;296:320–331.Google Scholar
- 18.Veterans Administration Cooperative Study of Atherosclerosis, Neurology Section. An evaluation of anticoagulant therapy in the treatment of cerebrovascular disease.Neurology 1961;11:132–138.Google Scholar
- 20.CONNELLY DP, OKUHN S, EHRENFELD WK. Long-term results of surgical therapy for amaurosis fugax. In: BERNSTEIN EF (ed).Amaurosis Fugax. New York: Springer-Verlag, 1988, pp 273–285.Google Scholar