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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-one patients who underwent 22 external carotid artery reconstructions for cerebral ischemia were reviewed. Ten patients had amaurosis fugax, 9 had hemispheric ischemia, and 2 were asymptomatic. With the exception of one patient, all had ipsilateral internal carotid artery occlusion and either external carotid stenosis or a cul-de-sac of the occluded internal carotid artery. Six patients had ipsilateral common carotid occlusions. The operative technique has been presented. There were no operative strokes or new neurologic deficits. All patients were relieved of symptoms. Patients were followed a mean of 32 months. During follow-up, 3 ipsilateral transient ischemic attacks occurred during the first 3 months. Four strokes occurred (one ipsilateral and three contralateral) from 4 to 33 months postoperatively. Ipsilateral stroke rate by life table analysis was 1 percent per year. These data suggest that external carotid artery reconstruction is a safe, effective, and durable therapeutic alternative for management of patients with cerebral ischemia and an ipsilateral occluded internal carotid artery. External carotid endarterectomy eliminates a potential source of emboli and increases cerebral perfusion. Because of the increase in cerebral blood flow, subsequent extracranial-to-intracranial bypass may be unnecessary.
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PMID:External carotid artery reconstruction: its role in the treatment of cerebral ischemia. 401 72

Seventy cases of retinal embolism showed cholesterol and platelet-fibrin emboli, usually from a carotid source, and calcific emboli, usually from a cardiac source, in that order of frequency. A marked preference for the temporal circulation, and particularly for the posterior pole, was observed with all the types of emboli. Only patients with cholesterol embolism complained of amaurosis fugax, whereas all the patients with calcific or stationary platelet-fibrin emboli experienced permanent visual loss. Visual field defects were characteristic of those seen with degeneration of the retinal axons. Collateral vessels usually developed with emboli to the arterioles of the disc and peripapillary region. Periarteriolar sheathing, as well as late fluorescein leakage from the impacted site, seemed to follow the cases of more severe endothelial damage due to cholesterol embolism. Subtotal nonprogressive ischemia ensued in relationship to post-embolic sheathing, which eventually disappeared, leaving a narrowed arteriole.
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PMID:Ophthalmologic findings in 70 patients with evidence of retinal embolism. 716 79

A recent study reported a 12.2% incidence of cerebral complications (5.2% permanent) after cerebral angiography in 147 patients. Because this was markedly different from our experience, we initiated a retrospective study of 301 patients who had undergone cerebral angiography for hemisphere transient ischemia or amaurosis fugax. There was only a 1.3% rate of transient complications (none permanent) in our patients. The benefits of cerebral angiography in patients with suspected cerebrovascular occlusive disease overwhelm the small potential risk of the procedure.
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PMID:Neurologic complications of angiography for cerebrovascular disease. 719 Oct 76

Seventeen patients with persistent amaurosis fugax ipsilateral to angiographically documented internal carotid artery (ICA) occlusions in the neck have been treated by the authors over the past 5 years. Complete cerebral arteriography in each case demonstrated that the symptomatic ophthalmic artery was perfused exclusively by the ipsilateral external carotid artery (ECA), which invariably had an obstructive and/or ulcerative lesion and its origin, and/or an adjacent residual "stump" of the occluded ICA. In nine patients, retinal artery branch emboli were visible on funduscopy. One patient had angiographic evidence of intracranial embolization via the ophthalmic artery from the ECA. Although ipsilateral superficial temporal-muscle cerebral artery anastomosis in one patient, and endarterectomy of a contralateral carotid stenosis in another patient, failed to relieve symptoms, endarterectomy of the ECA with resection of the "stump" of the occluded ICA effectively terminated symptoms in 10 of 11 patients. Anticoagulant drug therapy promptly abolished symptoms in four nonsurgical patients as well as in two patients with failed operations. It is concluded that recurrent retinal ischemia beyond cervical carotid occlusions frequently results from microembolism via the ipsilateral ECA. Patients with this mechanism of postocclusion recurrent ischemia can be identified on the basis of clinical history, ophthalmological examinations, and complete cerebral arteriography. Termination of embolic phenomena should be the major treatment goal in these individuals, and ECA endarterectomy is recommended. Anticoagulant drugs are an effective alternative treatment in patients who are poor surgical risks.
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PMID:Recurrent retinal ischemia beyond cervical carotid occlusions: clinical-angiographic correlations and therapeutic implications. 727 2

Serious antecedent neurologic events occurred in 86 patients operated on for fibromuscular dysplasia (FMD). We applied the following criteria to the assessment of outcome: (1) the lesion should be surgically accessible; (2) the operation should be performed with minimal risk; (3) the operative repair is durable; and (4) benefits of repair are long lasting. Intraluminal dilation fulfills the first criterion: 118 dilations have been performed in 79 patients, with no deaths, three postoperative strokes that recovered completely, and eight single episodes of transient ischemia or amaurosis. The repair was durable, there being one late closure of a dilated artery. There were two subarachnoid hemorrhages, two strokes, and two patients had recurrence of symptoms during the follow-up period. Intraluminal dilation should be offered to patients with symptomatic FMD. A registry of patients with asymptomatic FMD should be established to study its natural history.
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PMID:Why operate on carotid fibromuscular dysplasia? 743 20

Amaurosis fugax has been grouped together with other forms of transient ischemic attacks (TIAs) in the neurologic literature in analyses of prognosis. Although episodes of transient visual loss (TVL) are presumed to be due to ischemia, the prognosis with respect to subsequent stroke and myocardial infarct (MI) appears to differ from cerebral TIAs. We reviewed the clinical course of 73 patients above the age of 45 years who presented to our clinics with a distinct history of TVL. With an average follow-up period of 38 months, the incidence rates of cerebrovascular accident, cerebral TIA and MI following presentation with TVL were 1%, 4% and 7% respectively. Although there was a trend toward fewer episodes of amaurosis with use of acetylsalicylic acid (ASA), the difference was not statistically significant. In addition, ASA did not appear to offer a benefit with respect to future ischemic events. Patients with monocular TVL appeared more likely to experience a TIA, whereas those with binocular TVL appeared more likely to experience an MI.
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PMID:Amaurosis fugax: prognosis and the role of acetylsalicylic acid. 792 49

We described a 67-year-old right handed man with a left internal carotid artery occlusion, who developed monocular photopsia that supervened neovascular glaucoma. He had an antecedent transient motor aphasia. His photopsia, exaggerated by light, persisted intermittently. Orbital bruit was obtained on the left, more clearly during the photopsia. Brain MRI, cerebral angiography, and duplex sonography of carotid and ophthalmic arteries indicated left internal carotid artery (ICA) occlusion with collateral circulation through the ophthalmic artery. Visual evoked potentials (VEPs) revealed a prechiasmal disturbance of the optic pathway of the left side. The patient had carotid endarterectomy of the left ICA, and his visual disturbance has gradually improved. Ocular symptoms due to ICA ischemia are commonly transient visual loss with dark background known as amaurosis fugax. Neovascular glaucoma is sometimes complicated with carotid artery occlusion. However, photopsia associated with carotid artery occlusion is rare. Photopsia mimics scintillating scotomata, but the latter precedes migraine and is biocular and homonymous, ascribable to spreading depression from the occipital lobe. Retinal or prechiasmal optic pathway might be influenced by poor circulation of the ophthalmic artery. In addition, disturbance of light adaptation due to retinal hypoperfusion may be possible reason. Neovascular glaucoma is intractable, once developed. Therefore, atypical scintillating visual disturbance must be recognized as a sign of carotid artery insufficiency and supervened glaucoma to prevent it.
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PMID:[Monocular photopsia preceding with neovascular glaucoma due to internal carotid artery occlusion; a case report]. 874 54

Vasospasm has been implicated as a cause of amaurosis fugax, which can be controlled by administration of the calcium channel blockers nifedipine or verapamil. However, vasospasm has not previously been thought to be involved in chronic ocular ischemia. We report a patient with ocular ischemic syndrome, which may have had vasospasm as a contributing cause, since the patient also developed amaurosis fugax despite daily aspirin therapy. An 80-year-old man with chronic open-angle glaucoma developed chronic ocular ischemia characterized by progressively decreased visual acuity, pain, rubeosis, and hypotony, as well as transient visual dimming. Medical evaluation revealed no evidence of carotid stenosis, thromboembolism, or vasculitis as the cause of ocular ischemia. When the calcium channel blocker verapamil was administered, the episodes of transient visual dimming ceased immediately. In addition, soon thereafter, visual acuity improved, the rubeosis partially regressed, and the hypotony reversed. This case indicates that the calcium channel blocker verapamil may be effective in treating cases of ocular ischemic syndrome, when vasospasm is a contributing cause.
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PMID:Recovery from ocular ischemic syndrome after treatment with verapamil. 874 56

One of the most susceptible sites to vascular diseases is the optic nerve head. By innovative approaches using morphometry and in situ hybridization, vascular and extracellular characteristics of the human optic nerve head were examined. Nonarteritic ischemic optic neuropathy occurs due to vascular insufficiency within the optic nerve head. Various local and systemic risk factors have been proposed among which smoking and acute hypotension are now included. Anatomically abnormal discs such as the small optic disc, tilted disc, and optic nerve drusen are recognized as "disks at risk" and hyperopia may be an additional predisposing factor. Ocular, neurological, and vascular disorders due to giant cell arteritis were reviewed. Intravenous high-dose methylprednine should be administered in certain cases. Differentiating nonarteritic from arteritic ischemic optic neuropathy is sometimes difficult. Isolated choroidal ischemia or choroidal filling delay may be an indication of giant cell arteritis. Studies have been conducted on the vascular event, amaurosis fugax (transient monocular visual loss), and the results of some of these studies are discussed.
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PMID:Neuro-ophthalmic aspects of vascular disease. 1015 Aug 24

Occlusive disease of the innominate artery is relatively rare, but visual disturbance is a frequently encountered manifestation of this disease. A 48-year-old man presented with a 1-year history of right amaurosis fugaxs. During the nine years prior to admission, the patient had undergone aortic artery-coronal artery bypass surgery two times. Upon ophthalmological examination, the patient was found to have impaired right retinal sensitivity and prolonged right arm-to-retina circulation time. Aortic arch angiography demonstrated severe stenosis of the innominate artery near its origin. The stenosis was successfully treated by balloon angioplasty. Subsequently, right retinal sensitivity improved and right arm-to-retina circulation time normalized following the procedure. These findings indicate that this patient had sufferred impaired visual function due to hemodynamic retinal ischemia caused by innominate artery stenosis.
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PMID:[Improvement of visual function after balloon angioplasty for innominate artery stenosis: a case report]. 1119 32


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