transient vision loss

Question 1

ddx of amaurosis fugax (4)

Answer 1

• internal carotid artery atherosclerosis
• internal carotid artery dissection
• giant cell arteritis
• cardiac disease (including valvular disease, patent foramen ovale)

Question 2

most common cause of transient binocular vision loss

Answer 2

migraine

Question 3

monocular transient vision loss - urgent ddx (12)

Answer 3

cornea
- tear film instability

anterior chamber

• acute angle closure glaucoma
• uveitis

posterior chamber

• papilloedema
• retinal tears or detachment

posterior to the eye

• tumor compressing optic nerve
• optic neuritis

vascular supply to the eye

• incipient retinal vascular occlusion
• retinal vasospasm

broader vascular disease

• giant cell arteritis
• internal carotid artery disease
• cardiac disease

Question 4

investigations, management for amaurosis fugax

Answer 4

check for AF
- ECG
- Holter monitor test
carotid assessment
- carotid artery doppler ultrasonography

treat as a TIA -> ED for observation

Question 5

presentation of amaurosis fugax

Answer 5

curtain coming down over one eye

Question 6

binocular transient vision loss - ddx (5)

Answer 6

• migraine
• occipital tumor
• occipital arteriovenous malformation
• papilloedema
• vertebrobasilar insufficiency

Question 7

ddx for vertebrobasilar insufficiency

Answer 7

• vertebrobasilar artery stenosis
• emboli from atherosclerotic plaque
• arterial dissection
• giant cell arteritis

Question 8

vertebrobasilar artery perfuses what organs (6)

Answer 8

• medulla
• cerebellum
• pons
• midbrain
• thalamus
• occipital cortex

Question 9

transient vision loss - features suggesting temporal arteritis

Answer 9

jaw claudication

temporal scalp tenderness

Question 10

transient vision loss - symptoms suggesting tumor compressing optic nerve

Answer 10

vision loss present in a certain direction of gaze

Question 11

transient vision loss - symptoms suggest papilloedema

Answer 11

worse on coughing, bending or straining

Question 12

transient vision loss - symptoms suggesting acute angle-closure glaucoma

Answer 12

red, painful eye

Question 13

transient vision loss - symptoms suggesting vertebrobasilar insufficiency (5)

Answer 13

cerebellar signs

• vertigo
• gait disturbance

other neuro
- weakness, paraesthesia (unilateral or bilateral)

oral

• perioral numbness
• dysphagia