Diagnosing Amaurosis Fugax with Emergency Ultrasound
Article first published online: 15 DEC 2009
© 2009 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 17, Issue 1, page E7, January 2010
How to Cite
Stone, M. B. (2010), Diagnosing Amaurosis Fugax with Emergency Ultrasound. Academic Emergency Medicine, 17: E7. doi: 10.1111/j.1553-2712.2009.00617.x
- Issue published online: 4 JAN 2010
- Article first published online: 15 DEC 2009
A 66-year-old man with a history of hypertension presented to the emergency department with transient visual loss in his right eye. Physical examination revealed visual acuity of 20/30 in the unaffected eye and 20/40 in the affected eye with corrective lenses. With the exception of unilateral quadrantonopia in the affected eye on visual field testing, the physical exam, including a full neurologic examination, revealed no additional abnormalities.
Given the history of transient visual loss followed by a visual field deficit, the emergency physician suspected amaurosis fugax and performed a bedside ultrasound of the right carotid artery using a 12-3 MHz linear array transducer (Model HD11XE, Philips, Andover, MA). This exam was performed by placing the transducer over the right anterior neck and obtaining grayscale views of the common carotid artery in both longitudinal and transverse planes (Video Clips S1 and S2, available as supporting information). The exam demonstrated a near-complete occlusion of the distal common carotid artery, with fresh thrombus and reversal of diastolic flow (Figure 1). Noncontrast computed tomography revealed no acute abnormality, and the patient was admitted to the neurology service where angiography confirmed the severe carotid stenosis. The patient underwent an uncomplicated carotid end-arterectomy.
Video Clip S1. Longitudinal view of right common carotid artery demonstrates spontaneous contrast, reversal of diastolic flow, intraluminal thrombus, and calcified plaque at the vessel’s bifurcation.
Video Clip S2. Transverse view of the right common carotid artery demonstrates intraluminal thrombus and near-complete occlusion of the vessel at its bifurcation.
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