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  • Updated 03.04.2021
  • Released 04.13.1995
  • Expires For CME 03.04.2024

Amaurosis fugax

Introduction

Overview

Amaurosis fugax or transient vision loss may be caused by a multitude of pathologic processes, some of which may lead to stroke or blindness. The author reviews the current literature concerning the potential pathophysiologic mechanisms, diagnostic testing, and treatment strategies. In addition to noninvasive, accurate measurement of carotid artery stenosis, the identification of the vulnerable plaque at risk for rupture and stroke has aroused considerable interest. The section on prevention of stroke in patients with carotid steno-occlusive disease has been expanded to reflect the results of several completed clinical trials.

Key points

• Amaurosis fugax is transient monocular or binocular visual loss due to retinal artery ischemia.


• The risk of stroke following amaurosis fugax is lower than after an ischemic stroke.


• There are many causes of transient retinal ischemia that may require timely evaluation and treatment.


• Detection of a vulnerable plaque helps assess the risk of carotid artery stenosis.


• Internal carotid and ophthalmic arteries vasospasm and venous abnormalities should be suspected in patients with amaurosis fugax without internal carotid artery atherosclerosis.


• Revascularization of symptomatic carotid artery stenosis may prevent ischemic stroke if performed between day 3 to 14 after the initial ischemic event.


• Stenting of symptomatic carotid artery stenosis rivals, in experienced hands, with carotid endarterectomy.

Historical note and terminology

The meaning of amaurosis fugax or transient visual loss has varied throughout the years, reflecting the evolving understanding of potentially responsible disorders. In the early 1800s, amaurosis fugax merely referred to loss of sight (29). In the 1830s, the term described fleeting blindness, with no specification regarding laterality or etiology. In the early 1900s, the term “transient monocular blindness” was often used interchangeably with amaurosis fugax. The terms used encompassed a diverse set of symptoms, but only occasionally referred to a specific etiology of visual loss. In the past decade, amaurosis fugax has been defined as transient monocular visual loss, usually of vascular origin.

For the purposes of this review, the working definition of amaurosis fugax will be unilateral or bilateral transient visual loss due to retinal ischemia.

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