About
- Can identify significant carotid disease prior to having a full stroke
- Allows earlier initiation of stroke prevention
Aetiology
- Ophthalmic artery is first intracranial branch of internal carotid artery
- Thromboembolism from carotid or systemic embolic risk or low flow
Risks
- Diabetes
- Heart disease
- Smoking
- Hypertension
- Hyperlipidemia
- Advanced age
- Use of cocaine
Clinical
- Sudden onset of painless monocular blindness
- Clears within 30 min (usually 1.5 min)
- May be described as curtain coming down
- Often in someone with atherosclerosis
- Look for AF, murmurs, cardiomyopathy
Investigations
- FBC, U&E, ESR for GCA
- ECG for AF
- USS Doppler/CTA/MRA of carotids
- CT head / MRI to look for other evidence of stroke
- Echocardiogram may be needed
Pathology
- Suspect ipsilateral carotid stenosis
Differential of transient monocular visual loss
- Migraine aura
- Giant cell arteritis
- Hypotension
- Central retinal artery/vein occlusion
- Multiple sclerosis
- Papilloedema
- Sickle cell anemia
Management
- Risk assess and make diagnosis
- Smoking cessation and manage vascular risk factors - HTN, Diabetes, Lipids
- Clopidogrel 75 mg OD
- High Dose Atorvastatin
- Discuss Carotid endarterectomy if significant ipsilateral stenosis > 70% and good operative candidate
- Anticoagulate AF with DOAC or Warfarin