Advertisement

Annals of Vascular Surgery

, Volume 6, Issue 3, pp 281–288 | Cite as

Amaurosis fugax: Is it innocuous?

  • David Rosenthal
  • John C. Hungerpiller
  • Mark E. Crispin
  • Michael D. Clark
  • Pano A. Lamis
  • L. Laszlo Pallos
Original Articles
  • 7 Downloads

Abstract

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 words

Amaurosis fugax carotid endarterectomy stroke carotid artery lesions blindness 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    FISHER CM. Occlusion of the internal carotid artery.Arch Neurol Psych 1951;65:346–377.Google Scholar
  2. 2.
    VIRCHOW R. Zur Pathologis chen Anatomie der Neutchaut and des Sehnerven.Arch Pathol Anat Physiol Khn Med 1856;10:170.Google Scholar
  3. 3.
    FISHER CM. Transient monocular blindness associated with hemiplegia.AMA Arch Ophthal 1952;47:167–203.Google Scholar
  4. 4.
    FISHER CM. Clinical picture of cerebral arteriosclerosis.Minn Med 1955;38:839–851.PubMedGoogle Scholar
  5. 5.
    MILLIKEN C, KETY SS, FISHER CM. Cerebrovascular disease.Neurology 1956;6:580–593.PubMedGoogle Scholar
  6. 6.
    MARSHALL J, MEADOWS J. The natural history of amaurosis fugax.Brain 1968;91:419–434.PubMedGoogle Scholar
  7. 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
  8. 8.
    HURWITZ BJ, HEYMAN A, WILKINSON WE, et al. Comparison of amaurosis fugax and transient cerebral ischemia. A prospective clinical and arteriographic study.Ann Neurol 1985;18:698–704.PubMedGoogle Scholar
  9. 9.
    POOLE CJM, ROSS-RUSSELL RW. Mortality and stroke after amaurosis fugax.J Neurol Neurosurg Psychiat 1985;48:902–903.PubMedGoogle Scholar
  10. 10.
    TOREM S, ROSSMAN ME, SCHNEIDER PA, et al. The natural history of amaurosis fugax with minor degrees of internal carotid artery stenosis.Ann Vasc Surg 1990;4:46–51.PubMedGoogle Scholar
  11. 11.
    SCHWARCZ TH, ETON D, ELLENBY MI, et al. Hollenhorst plaques: retinal manifestations and the role of carotid endarterectomy.J Vasc Surg 1990;11:635–641.PubMedGoogle Scholar
  12. 12.
    The Amaurosis Fugax Group. Current management of amaurosis fugax.Stroke 1990;21:201–208.Google Scholar
  13. 13.
    FIELDS WS, LEMAK NA, FRANKOWSKI RF, et al. Controlled trials of aspirin in cerebral ischemia.Stroke 1977;8:301–316.PubMedGoogle Scholar
  14. 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
  15. 15.
    BOUSSER MG, ESCHWEGE E, HAGVENAU M, et al. AJCLA controlled trial of aspirin and dipyridamole in the secondary prevention of atherothrombotic cerebral ischemia.Stroke 1983;14:5–14.PubMedGoogle Scholar
  16. 16.
    Antiplatelet Trialists Collective Observation. Secondary prevention of vascular disease by prolonged antiplatelet therapy.Br Med J 1988;296:320–331.Google Scholar
  17. 17.
    CAIRNS JA, GENT M, SINGER J, et al. Aspirin, sulfinpyrazone or both in unstable angina: results of a Canadian multicenter trial.N Engl J Med 1985;313:1369–1375.PubMedGoogle Scholar
  18. 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
  19. 19.
    BERNSTEIN EF, DILLEY RB. Late results following carotid endarterectomy for amaurosis fugax.J Vasc Surg 1987;6:333–340.PubMedGoogle Scholar
  20. 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

Copyright information

© Annals of Vascular Surgery Inc. 1992

Authors and Affiliations

  • David Rosenthal
    • 1
  • John C. Hungerpiller
    • 1
  • Mark E. Crispin
    • 1
  • Michael D. Clark
    • 1
  • Pano A. Lamis
    • 1
  • L. Laszlo Pallos
    • 1
  1. 1.From the Department of Vascular Surgery, Georgia Baptist Medical CenterMedical College of Georgia, and the Agency for Toxic SubstancesAtlantaGeorgia

Personalised recommendations