Amaurosis fugax: The Daily PANCE Blueprint
Which of the following tests should be obtained first in the evaluation of transient vision loss?
A. Temporal artery biopsy
B. ESR and CRP levels
C. Non-contrast CT head
D. Echocardiogram
E. MRI brain with and without contrast
Answer and topic summary
The answer is C. Non-contrast CT head
Amaurosis fugax (transient monocular or binocular visual loss) reflects a heterogeneous group of disorders. The two more common causes are carotid artery disease or giant cell arteritis. Other etiologies include retinal vein occlusion, optic neuropathy, retinal migraines, and papilledema. All patients need a non-contrast CT head. You should then obtain a carotid duplex ultrasound as well to rule out carotid disease. You just really want to make sure the patient didn’t have a TIA due to a dislodged emboli.
Giant cell arteritis can be worked up with ESR/CRP levels and a temporal artery biopsy. Once GCA and carotid pathology have been excluded, patients can be referred to receive a cardiac evaluation for a cardiac source of embolism (e.g., PFO, ASD, etc).
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