Amaurosis fugax: The Daily PANCE Blueprint

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Amaurosis fugax: The Daily PANCE Blueprint

A 73-year-old male with a history of tobacco abuse, hyperlipidemia, and diabetes presents to ER due to loss of vision. He was walking in his house and suddenly lost vision in his left eye. His symptoms resolved once EMS arrived. The vitals are unremarkable. Neurological exam shows intact cranial nerves and 5/5 strength in upper and lower extremities. Gait and balance are stable. Non-contrast CT reveals chronic microvascular changes, but no acute issue. What is the next best step?

A. Conservative management
B. Heparin drip then oral anticoagulation
C. MRI brain
D. Ultrasound of the neck
E. Systemic tPA

Answer and topic summary

The answer is D. Ultrasound of the neck

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 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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Covered under ⇒ PANCE Blueprint EENT ⇒ Vision abnormalities (PEARLS) ⇒ Amaurosis fugax

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