The Sign of the Cross
Author links open overlay panelAryanPashaei-Marandi1AshwiniKiniMD2BayanAl Othman2Andrew G.LeeMD23JulieFalardeauMD4
1
– University of Texas Medical Branch at Galveston, Galveston, TX
2
– Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX,
3
-Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine
4
-Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
Received 14 May 2019, Accepted 20 May 2019, Available online 24 May 2019.
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https://doi.org/10.1016/j.survophthal.2019.05.002Get rights and content
Abstract
A 46-year-old man developed acute, painful, transient, right sided, monocular visual loss lasting four hours. This was followed by headache and left sided transient hemiparesis. The association of ipsilateral transient vision loss with transient contralateral hemiparesis implicates involvement of the ipsilateral internal carotid artery (i.e., a crossed symptom).
Case report
A 46-year old man developed acute, painful, recurrent, transient monocular visual loss in the right eye (OD). He described irregular spots of bright light in his central visual field OD that lasted four hours. The episodes occurred when supine and improved when standing. They were associated with right eye pain and a right-sided headache. One day later he experienced three episodes of transient left arm and leg weakness and numbness lasting 10-15 minutes. He was on vacation in Colombia and had engaged in an evening of heavy alcohol consumption the night before the visual loss, but denied drug use. The patient was admitted to the Houston Methodist Hospital for further evaluation.
Past medical, ocular, surgical, and family history were unremarkable. His medications included prophylactic emtricitabine and tenofovir for his relationship with an HIV-positive partner. Social history was significant for weekly social alcohol consumption, but no tobacco or illicit drug use.
The patient was completely asymptomatic at the time of his ocular evaluation. Neuro-ophthalmic examination showed a best corrected visual acuity of 20/20 in both eyes. The pupils were equal and reactive, without anisocoria or a relative afferent pupillary defect. Extraocular motility was normal. The remainder of the ocular and neurologic examinations were normal with no residual hemisensory loss or hemiparesis.
Keywords
internal carotid dissectioncross signamaurosis fugaxvision losshemiparesis
Keywords
internal carotid dissectioncross signamaurosis fugaxvision loss
Financial Support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interest: No conflicting relationships exist for any author.
Disclosures
There are no conflicts of interest to disclose
Method of literature search
Literature was researched on PubMed. Pertinent keywords were searched, including but. not restricted to “carotid dissection”, “amaurosis fugax”, “vision loss”. Articles relevant to the discussion were selected from these search results.
© 2019 Published by Elsevier Inc.
Author links open overlay panelAryanPashaei-Marandi1AshwiniKiniMD2BayanAl Othman2Andrew G.LeeMD23JulieFalardeauMD4
1
– University of Texas Medical Branch at Galveston, Galveston, TX
2
– Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX,
3
-Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine
4
-Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
Received 14 May 2019, Accepted 20 May 2019, Available online 24 May 2019.
Show less
https://doi.org/10.1016/j.survophthal.2019.05.002Get rights and content
Abstract
A 46-year-old man developed acute, painful, transient, right sided, monocular visual loss lasting four hours. This was followed by headache and left sided transient hemiparesis. The association of ipsilateral transient vision loss with transient contralateral hemiparesis implicates involvement of the ipsilateral internal carotid artery (i.e., a crossed symptom).
Case report
A 46-year old man developed acute, painful, recurrent, transient monocular visual loss in the right eye (OD). He described irregular spots of bright light in his central visual field OD that lasted four hours. The episodes occurred when supine and improved when standing. They were associated with right eye pain and a right-sided headache. One day later he experienced three episodes of transient left arm and leg weakness and numbness lasting 10-15 minutes. He was on vacation in Colombia and had engaged in an evening of heavy alcohol consumption the night before the visual loss, but denied drug use. The patient was admitted to the Houston Methodist Hospital for further evaluation.
Past medical, ocular, surgical, and family history were unremarkable. His medications included prophylactic emtricitabine and tenofovir for his relationship with an HIV-positive partner. Social history was significant for weekly social alcohol consumption, but no tobacco or illicit drug use.
The patient was completely asymptomatic at the time of his ocular evaluation. Neuro-ophthalmic examination showed a best corrected visual acuity of 20/20 in both eyes. The pupils were equal and reactive, without anisocoria or a relative afferent pupillary defect. Extraocular motility was normal. The remainder of the ocular and neurologic examinations were normal with no residual hemisensory loss or hemiparesis.
Keywords
internal carotid dissectioncross signamaurosis fugaxvision losshemiparesis
Keywords
internal carotid dissectioncross signamaurosis fugaxvision loss
Financial Support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interest: No conflicting relationships exist for any author.
Disclosures
There are no conflicts of interest to disclose
Method of literature search
Literature was researched on PubMed. Pertinent keywords were searched, including but. not restricted to “carotid dissection”, “amaurosis fugax”, “vision loss”. Articles relevant to the discussion were selected from these search results.
© 2019 Published by Elsevier Inc.
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