Friday, January 29, 2010

Dark Fleeting

A 60 year old man comes to urgent care clinic. He says that an hour ago, he experienced vision loss in one eye; he covered each eye separately to test vision. The vision loss was painless and lasted several minutes. The fundoscopic exam is shown above. Currently, his vision is normal and neurologic exam is unremarkable.

Challenge: This is a tough case, but what's the most likely etiology?

Related Questions:
1. What is the symptom described here called?
2. What is the finding in the fundoscopic exam?

Image shown under Fair Use.


Suheil said...

Amaurosis Fugax? Probably an embolic occlusion of the central retinal artery.. Probably TIA because the symptom has resolved..
The findings are those of diabetic retinopathy??

Craig Chen said...

yes! amaurosis fugax 2/2 embolus.. very well done!
Dark Fleeting

Amaurosis (Greek "Dark") fugax (Latin "fleeting") refers to transient loss of vision in one or both eyes. The image shows a Hollenhorst plaque or a cholesterol crystal in a retinal artery. This typically occurs at vascular bifurcations and has a highly refractile appearance. It is a sign of ipsilateral carotid artery disease leading to thromboembolism to the retinal artery.

Sources: UpToDate;