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Vasospastic amaurosis fugax
  1. Josef G Heckmann1,
  2. Charly Gaul1,
  3. Bernhard Neundörfer1,
  4. Joanna Harazny2,
  5. Georg Michelson2
  1. 1Department of Neurology, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
  2. 2Department of Ophthalmology, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
  1. Correspondence to:
    Dr Josef G. Heckmann, Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany;
    josef.heckmann{at}neuro.imed.uni.erlangen.de

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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.

The retinal perfusion map using scanning laser Doppler flowmetry demonstrates revealed impaired perfusion of the retinal temporal artery at the 11 and 12 o’clock positions (arrows in A) with resolution within 21 min (B).

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