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Ripa M, Shah NA, Schipa C, Aceto P, Donati T. The Relationship between Ischemic Optic Neuropathy and Internal Carotid Artery Dissection: A Systematic Review. J Clin Med 2024; 13:2486. [PMID: 38731015 PMCID: PMC11084818 DOI: 10.3390/jcm13092486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background: To evaluate and review the current evidence regarding the association between ischemic optic neuropathy (ION) and internal carotid artery dissection (ICAD). Methods: We systematically reviewed studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA), searching three databases (Scopus, Pubmed, and Embase) for relevant articles that clearly described the correlation between ION and ICAD. All studies that examined the association between ICAD and the development of ION were synthesized. Quality assessment using the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and Case Series were conducted. Results: Our search yielded 198 manuscripts published in the English language. Following study screening, fourteen studies were selected. The number of participants with ION following ICAD ranged from one to four, with sixteen patients experiencing either anterior ION, posterior ION, or a combination of both. The anterior or posterior ischemic optic neuropathy (AION and PION) patients' ages were 48.75 ± 11.75 and 49.62 ± 12.85, respectively. Fourteen out of sixteen patients experienced spontaneous ICAD, whereas the traumatic etiology was ascertained in two patients. Conclusions: Hence, albeit rare, ophthalmologists should consider ICAD a potential cause of ION, especially in young adults with concomitant cephalic pain and vision reduction.
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Affiliation(s)
- Matteo Ripa
- Department of Ophthalmology, Sankara Eye Hospital, Jaipur 302039, Rajasthan, India
| | - Neeraj Apoorva Shah
- Department of Ophthalmology, Sankara Eye Hospital, Jaipur 302039, Rajasthan, India
| | - Chiara Schipa
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Paola Aceto
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Tommaso Donati
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Nandwani K, Thng SY, Anaikatti P. An Internal Carotid Artery Dissection Masquerading as Optic Neuritis: A Case Report. Cureus 2021; 13:e12810. [PMID: 33628678 PMCID: PMC7894247 DOI: 10.7759/cureus.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Carotid artery dissection is an important cause of stroke, especially in the young. We present a 43-year-old lady, with a known background of headaches, who was referred to the Emergency Department with a headache, dilated pupil, and acute monocular blurring of vision. She was later found to have an internal carotid artery dissection (ICAD) with diffuse ipsilateral hemispheric involvement after being initially managed for atypical optic neuritis. This case report aims to provide further insight into an atypical presentation of a carotid artery dissection, with the intent of assisting the clinician in identifying such cases during the initial presentation.
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Affiliation(s)
| | - Shin Ying Thng
- Accident and Emergency, Changi General Hospital, Singapore, SGP
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Song JX, Lin XM, Hao ZQ, Wu SD, Xing YX. Ocular manifestations of internal carotid artery dissection. Int J Ophthalmol 2019; 12:834-839. [PMID: 31131245 DOI: 10.18240/ijo.2019.05.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Abstract
Internal carotid artery dissection (ICAD) results from disruption of the intima of the arterial wall, and can lead to intrusion of blood into the arterial wall and form an intramural hematoma. The hematoma can compress the true lumen of the vessel, causing functional stenosis or occlusion. The classic triad signs of ICAD include pain in the ipsilateral neck, head and orbital regions; a (partial) Horner syndrome; and cerebral or retinal ischemia. However, not all ICAD patients present with this classic signs. In some cases, ocular manifestations are the initial (and sometimes the only) findings. We summarize the ocular manifestations associated with ICAD in 3 categories: visual symptoms, oculosympathetic palsy, and ocular motor nerve palsy.
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Affiliation(s)
- Jin-Xin Song
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China.,Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xue-Mei Lin
- Department of Neurology, the First Hospital of Xi'an; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Zhao-Qin Hao
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Song-Di Wu
- Department of Neurology, the First Hospital of Xi'an; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Yong-Xin Xing
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
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Kleinberg TT, Uretsky S, Flanders AE, Bilyk JR, Murchison AP. Black as night. Surv Ophthalmol 2014; 60:269-73. [PMID: 25311430 DOI: 10.1016/j.survophthal.2014.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/20/2022]
Abstract
A 30-year-old man presented with painless total visual loss in the right eye. Fundus exam and imaging was consistent with total internal carotid artery occlusion and hemispheric stroke. The presentation and management options of retinal vascular occlusive disease in association with asymptomatic stroke are discussed.
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Affiliation(s)
| | - Scott Uretsky
- Division of Neuro-Ophthalmology, Neurological Surgery P.C., Lake Success, NY, USA
| | - Adam E Flanders
- Division of Neuroradiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jurij R Bilyk
- Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ann P Murchison
- Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
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Correa E, Martinez B. Traumatic dissection of the internal carotid artery: simultaneous infarct of optic nerve and brain. Clin Case Rep 2014; 2:51-6. [PMID: 25356244 PMCID: PMC4184630 DOI: 10.1002/ccr3.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/05/2014] [Accepted: 01/25/2014] [Indexed: 11/10/2022] Open
Abstract
KEY CLINICAL MESSAGE Traumatic intracranial internal carotid artery dissection is a rare but significant cause of stroke in patients in their forties, leading to high morbidity and mortality. Simultaneous ischemic stroke and optic nerve infarction can occur. Clinical suspicion of dissection is determining in the acute management.
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Affiliation(s)
- Edgar Correa
- Department of Neurology, Andrade Marín Hospital, San Francisco of Quito UniversityQuito, Ecuador
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Lysandropoulos AP, Carota A. Diagnostic pitfalls: posterior ischemic optic neuropathy mimicking optic neuritis. Clin Neurol Neurosurg 2010; 113:162-3. [PMID: 21056537 DOI: 10.1016/j.clineuro.2010.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 09/07/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
In young people, the most frequent cause of isolated monocular visual loss due to an optic neuropathy is optic neuritis. We present the case of a 27 year old woman who presented monocular visual loss, excruciating orbital pain and unusual temporal headache. The initial diagnosis of optic neuritis revealed later to be a posterior ischemic optic neuropathy (PION). In this case, PION was the first unique presentation of a non-traumatic carotid dissection, and it was followed 24h later by an ischemic stroke. Sudden monocular visual loss associated with a new-onset headache are clinical symptoms that should immediately prompt to a carotid dissection.
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Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye (Lond) 2004; 18:1188-206. [PMID: 15534605 DOI: 10.1038/sj.eye.6701562] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate and present a comprehensive account of the clinical features, pathogenesis, and management of posterior ischaemic optic neuropathy (PION). METHODS This retrospective study is based on 53 consecutive eyes of 42 patients with PION seen in my clinic since 1973, who fulfilled the inclusion criteria. They were systematically evaluated, treated, and followed by me. All patients had initially detailed ophthalmic evaluation of the anterior and posterior segments, including visual field with Goldmann perimeter and fluorescein fundus angiography. All patients aged 50 years and older were also investigated for giant cell arteritis (GCA). Every attempt was made to rule out other causes of visual loss. Follow-up evaluation was similar to the initial evaluation except angiography. Aetiologically, PION can be divided into three types: arteritic due to GCA, nonarteritic not due to GCA, and surgical following a surgical procedure. Steroid therapy was given to only those nonarteritic PION patients who opted to try that, but was given to all arteritic PION patients. RESULTS PION was nonarteritic in 28 patients (35 eyes), arteritic in 12 (14 eyes), and surgical in three (four eyes). Visual acuity varied between 20/20 and no light perception--it was count fingers or less in 19 of 35 eyes with nonarteritic PION, four of 14 in arteritic, and all four with surgical PION. The most common visual field defect was central visual loss, alone or in combination with other types of visual field defects. Initially, optic disc and fundus showed no abnormality but the disc usually developed pallor in about 6-8 weeks. Aggressive treatment with high-dose systemic steroid during the very early stages of nonarteritic PION produced significant improvement of visual acuity as well as visual fields, but not so in arteritic or surgical PION. However, some spontaneous visual improvement also occurred in some untreated nonarteritic PION cases. CONCLUSIONS PION is a distinct clinical entity but should be diagnosed only after exclusion of all other causes of visual loss. In all patients older than 50, GCA must be ruled out. There is usually marked visual loss, with central field defect being the most common. The study suggests that high-dose steroid therapy in nonarteritic PION, soon after the onset of visual loss, resulted in significant visual improvement compared to the untreated cases, but not in arteritic and surgical PION.
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Affiliation(s)
- S S Hayreh
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA 52242-1091, USA.
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Buono LM, Foroozan R, Savino PJ, Danesh-Meyer HV, Stanescu D. Posterior ischemic optic neuropathy after hemodialysis. Ophthalmology 2003; 110:1216-8. [PMID: 12799249 DOI: 10.1016/s0161-6420(03)00257-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report a case of visual loss from posterior ischemic optic neuropathy (PION) after hemodialysis. DESIGN Observational case report. METHODS Neuro-ophthalmic examination, neuro-imaging including computed tomography (CT) scan, magnetic resonance imaging (MRI) of the head and orbits, and magnetic resonance angiography (MRA) of the neck and cerebral vasculature, as well as electrophysiologic testing including electroretinogram (ERG) and visually evoked response (VER) were performed. RESULTS Acute onset of painless bilateral no light perception vision with absent pupillary response to light and normal funduscopic examination occurred shortly after completion of hemodialysis. Computed tomography scan and MRA results were normal. Magnetic resonance imaging scan showed small vessel ischemic white matter changes. Electroretinogram results were normal and the VER was unrecordable. CONCLUSIONS Visual loss after hemodialysis is a rare complication and is associated with anemia and hypotensive events. The visual loss is usually a result of anterior ischemic optic neuropathy. We were unable to find another instance in the literature of visual loss after hemodialysis resulting from PION.
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Affiliation(s)
- Lawrence M Buono
- Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Abstract
This chapter discusses the cases of postoperative blindness reported in the literature and the theories that attempt to explain the mechanisms involved. Although uncommon, alterations in vision and blindness after anesthesia for major surgical procedures, particularly cardiopulmonary bypass or spine surgery, are well documented, with an incidence varying between 0.05% and 1%. Accurate incidence data are unavailable because it is not known what percentages are reported. However, the large number of case reports over many years has provided some significant information. Although sustained compression of the eye is an important cause, postoperative visual loss may also occur, in an unrelated manner, because of ischemic optic neuropathy, central retinal artery or vein occlusion, or cortical blindness.
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Affiliation(s)
- E Lynne Williams
- Department of Anesthesiology, University of Pittsburgh, A1305 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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