sally webber presentation on tia
Post on 22-Apr-2015
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Sally Webber
TRANSIENT VISUAL LOSS
What’s the most important feature?
TRANSIENT VISUAL LOSS
Monocular or binocular?
Duration
Characteristics
Examination findings
TRANSIENT VISUAL LOSS
Monocular or binocular?
TRANSIENT VISUAL LOSS
Monocular or binocular?
Difficult as patients may report uniocular symptoms for migraine
Or patients may notice only the temporal side of a
homonomous visual field defect
TRANSIENT VISUAL LOSS
Duration?
TRANSIENT VISUAL LOSS
Visual obscurations
Amaurosis Fugax
Prolonged visual loss
TRANSIENT VISUAL LOSS
Visual obscurations:
last seconds to minutes
Causes?
TRANSIENT VISUAL LOSS
Visual obscurations: seconds to minutesCauses?
Lots!
VISUAL OBSCURATIONS
Causes
Optic neuritis with Uhthoff’s phenomonenRetinal migrainePapilloedemaIntermittant angle closure glaucomaPituitary tumour
VISUAL OBSCURATIONSSurface problems
○ Watery, dry, sticky
Vitreous floaters
Varifocals/bifocals/contact lenses
No obvious cause
Diagnosis mainly needs
Careful history
and on examination?
Examination tip
Usual ocular examination
IncludingIOPVisual fieldCareful check of the disc (dilate if possible)
TRANSIENT VISUAL LOSS
Amaurosis Fugax
Duration?
Symptoms?
Amaurosis Fugax
Lasts one to five minutes
Amaurosis Fugax
Symptoms○ Over 50 years○ Complete loss all or part of Visual field○ ‘Like a curtain’○ Normal vision in other eye○ No systemic/neurological symptoms
Amaurosis Fugax
• Examination• Vision, anterior segment and IOP• Visual field • Dilate pupils, look at disc, follow all retinal
arterioles to look for emboli
Amaurosis Fugax
Ask about risk factors?
Amaurosis Fugax
Ask about risk factors
○ Over 50 years○ Hypertension○ Diabetes○ Heart trouble, heart attack, angina○ Stroke, TIA
Amaurosis Fugax
Management?
Amaurosis Fugax
Management
○ Refer to GPAsk for Assessment for STROKE RISK FACTORS or
referral to the RUH STROKE CLINIC
○ Refer to Eye department to confirm diagnosis
PROLONGED MONOCULAR VISUAL
LOSS
Fifteen to sixty minutes Causes
Hypertension and blood disorders‘Retinal migraine’
PROLONGED VISUAL LOSS Fifteen to sixty minutes Causes
Hypertension and blood disorders‘Retinal migraine’
○ Rare, spasm of choroidal circulation○ Young adults○ Patchy/fading visual loss in one eye○ No positive visual phenomena○ No other neuro symptoms/signs
TRANSIENT BINOCULAR VISUAL LOSS Migraine Bilateral disease, optic nerve/angle
closure Brain tumour or Arteriovenous
malfomation Vertibrobasilar TIA or insufficency
MIGRAINE
MIGRAINE Expanding
scintillating scotoma 10-30 mins Scotoma surrounded by
Zig-zagsFlashesSparklesWaves/watery
NORMAL EXAMINATION
RETINAL ARTERY OCCLUSION
Embolus causing permenant occlusion
RETINAL ARTERY OCCLUSION
Embolus causing permenant occlusion
Complete visual loss/dense scotoma
Pale retina
Embolus may be visible
Cherry red spot
TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION?
TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION Waiting
Dilation of the artery Sub-Lingual vasodialtorsRe-breathing expired carbon dioxide
Removal of physical obstruction Eye massage
TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION
Increasing arterial perfusion pressure by reduction of intra ocular pressure
Anterior chamber paracentesis Intravenous DiamoxIntravenous Maritol
THROMBOLISIS
Anti-platelet therapy Steroids Reducing red blood cells rigidity
Pentoxifylline has been tried
Transient visual loss
Careful history
Visual fields
Check the discs
Remember the stoke clinic
Thank you
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