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A 54 year old man was admitted because of repeating (10–12/day) visual disturbances in the left eye. He reported shrinkage of the visual fields and a shadow-like visual impairment progressing to complete darkness within about 3 min and lasting about 10 min, followed by complete recovery. There was no personal history of hypertension, diabetes, and smoking. General medical examination was normal. The blood pressure was 130/80 mm Hg. Investigations of standard haematological and biochemical parameters revealed elevated low density lipoprotein cholesterol 4.45mmol/L (normal < 3.35 mmol/L) and elevated triglycerid level 2.67 mmol/L (normal range 0.45–1.80 mmol/L). Ultrasound studies of the extracranial vessel showed normal intima-media thickness (0.9 mm) and no plaque formation in the carotid bulb. Complete cardiological examination, including electrocardiography, transthoracic echocardiography, and chest x rays, were unremarkable. Magnetic resonance imaging of the brain was unremarkable, as was conventional angiography.
During examination of the retinal circulation by laser Doppler by scanning laser Doppler flowmetry1 elaborating a map of perfused retinal vessels and capillaries, the patient suffered a visual disturbance as described above. The retinal perfusion map ( fig 1A⇓) revealed impaired perfusion of the retinal temporal artery at the 11 and 12 o’clock positions (arrows), which resolved within 21 min (Fig 1B⇓). A treatment with statin to lower lipids and the antiplatelet agent copidogrel was initiated, but without influence on the events. Suspecting vasospastic amaurosis fugax,2–,4 we supplemented the therapy by calcium-channel blocker cyclandelate (1200 mg daily),2 which yielded significant improvement of the clinical condition.
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