Amaurosis fugax

[Asbeck]

I have GCA and PMR. I had thought that all I needed to worry about is Prednisone. I described to one of my doctors a small eye incident. My eye exam was good. But he diagnosed Amauroses fugax, from my description of the incident: Early morning; one eye; very short in duration; sort of looking through snow or the static on a TV, when not placed on a correct channel. I had not heard that symptom precisely described. I didn't worry too much about it at the time. I'm happy that the doctor is on it. But he ordered my carotid arteries looked at and maybe an echo cardiogram and other tests, I guess from a heart doctor and maybe a neurologist. (I was relaxed about the 6 months to see him again [described below]and wasn't paying really close attention.) He wants the tests NOW, and apparently can get them. (It's a renown eye hospital associated with a good general hospital.) I had wanted to wait until May--after my April vacation. This doctor (a neuro ophthalmologist) seems not to want to alarm people. He's very low key. He has fellows and residents and technicians (optometrists and oculists and people who run machines with lights, etc.) who see me first, and he directly says only minimal things. I have seen him often. He told me that I had not had an ischemia of an eye artery and that he probably didn't need to see me again for 6 months. (I have a rheumatologist.) Then he grilled me about eye symptoms - I guess to make sure before he let me wait longer to see him. (I had told the other MDs and professionals about the symptom in an earlier appointment.) So in response to the grilling I spoke directly to him of the symptom. He didn't explain in depth, and certainly down played the symptom. (He said: "I've never heard of that.") But bang, then the diagnosis was on the report. I'm happy he acted. But what is this? Does anyone know? I didn't even know about the diagnosis until I looked on a Hospital Health summary form which is available to me on line. And with regard to him being low key--maybe he's right. I'm now worried and sort of depressed. He wants the tests done before I go. He said: "You have 4 weeks before you go. Let's do it now." I tried to google the situation. It's apparently sometimes a symptom of GCA, but people without GCA can get it. Without GCA I guess that people worry about a stroke and ????emboli??? With GCA, I'm not sure. He doesn't see anything during the eye exam. Does anyone know anything about this? Sorry about the length of this. But I would really appreciate any help you can give me.

[Celestee]

I had a droopy eye last year then after a week went to the Dr. He did'nt know what it was at 1st so ordered an MRI, some antibiotics (in case it was a sinus infection) and to see an eye Dr. Did the MRI immediatly, filled the prescription then next day went to eye Dr.

while at eye Dr says my eye look fine just need glasses (which I knew) but he called for MRI results. Once he read results he said "you had a stroke". My response was "WHEN"?

so since back to Dr and now cardioligist. recently diagnosed with PMR because I've been in so much pain. Bloodwork determined PMR.

One constant is an Eye ache that happens more than 2 times a week. Mostly in the evening or when im tired.

Was recently sent to neurologist. He wants to do a CT scan to see the vascular part. Ruling out an anureism.

Ive most likely had PMR and or GCA for awhile now just didnt know it. Likely reason for stroke.

High blood pressure, potassium and viamin D deficient.

Am walking more and being more active. Eat healthier. Always cold.

Didnt have the TV disturbance in my vision but do have the pain as if I was punched in eyeball. It comes and goes.

looking for answers once the CT scan happens.

[Asbeck in reply to Celestee]

Thank you Pascua! This was very helpful. I'm also getting some tests. I hope that your CT scan gives your doctors the information which they need. God speed to you.

[PMRpro Ambassador]

All that amaurosis fugax means (Latin fugax meaning fleeting, Greek amaurosis meaning darkening, dark, or obscure) is a painless transient monocular visual loss (i.e., loss of vision in one eye that is not permanent).

Like PMR symptoms it is not the disease itself, it is the symptom of another problem. There are five classes depending on the primary cause: embolism, haemodynamic, optical, neurological or idiopathic (no cause identified). Some of the more frequent causes include atheromatous disease of the internal carotid or ophthalmic artery, vasospasm, optic neuropathies, giant cell arteritis, angle-closure glaucoma, increased intracranial pressure, orbital compressive disease, a steal phenomenon, and blood hyperviscosity (thickened blood) or hypercoagulability (blood that clots too easily).

Carotid causes can either be due to atherosclerosis (plaques breaking off) or to reduced blood flow because of the narrowing so they need a carotid scan to rule that out. Another cause can be clots originating in the heart, atrial fibrillation is one cause but there are others, that's why they want to do an echocardiogram. There are other tests to be done as well to rule out the many possible causes.

Amaurosis fugax can be a sign you have had a TIA. a transient ischaemic attack, otherwise known as a mini-stroke. The difference is that in a TIA the symptoms resolve in 24 hours or so. However, having one can be a sign that you are at risk of having a stroke within the next few years so having had the warning they like to identify possible causes to be able to minimise the longer term risk.

Obviously the doctor prefers to do these tests as soon as possible - there is no way of knowing what the cause is without them and you could just as likely end up with an "idiopathic" classification as any other. On the other hand, if there is an underlying cause they are able to deal with it more easily the earlier it is identified - and the sooner it is done, the less likelihood there is of another episode.

GCA can actually cause stroke too when untreated but yes, you are correct in supposing the concern is for stroke or other emboli. He hasn't seen any sign on the retina of something called anterior ischemic optic neuropathy (AION) which is a medical condition involving loss of vision due to damage to the optic nerve from insufficient blood supply - it shows up as a change in the appearance of the optic nerve where it joins the retina and it is what happens in GCA when it affects vision - you can have GCA without it leading to blindness, it depends on which arteries are affected. Because he doesn't see that it probably increases his suspicions of another cause of the amaurosis fugax and he wants to find out which.

In my experience, the doctors who are low key often increase the fears on the part of the patient - and that seems to me to be what has happened with you. He has become aware of a possible problem and he is arranging to do the detective work. Amongst other things, a cough is one of the symptoms of lung cancer - but you don't panic that you have lung cancer every time you have a cough do you? It is more likely to be a cold, bronchitis or very very occasionally maybe even pneumonia. To me, this is the same sort of thing - let him arrange the tests to be done asap - and when they find nothing you will be able go off on your vacation with nothing to worry about.

There you are - no need to apologise for a long question - my reply is even longer!!!

[Asbeck in reply to PMRpro]

This is Asbeck again. I have had an ultrasound of the carotid arteries, but not intra-cranial. So they looked at what they could reach in the neck. When the tech pressed hard on the right artery, I saw large black spots in the right carotid for a few seconds. Don't know if that's another amaurosis Fugax. But at least that test is done. The doctor should have it tomorrow. I have been taking 7.5 mg Pred and have been having minor problems with the grey dots in my peripheral vision in the morning, some Wegener's-like nose symptoms, some symptoms in the temporal arteries and a sensation of short duration of heat in the artery on the inside of my right arm near the elbow, along with more fatigue. So I bit the bullet and took 7.75 mg Pred this morning in hopes that the problem is simply that I'm taking just barely enough Pred. My doctors don't seem to worry too much about the Pred dose. They let me set it. The tech said that the ultra sound was good except "maybe for a small part where the artery goes into the cranium." She was very clear that I would need another test if the doctors wanted to check out the intra cranium carotid artery--that she couldn't see it. But at least I seem to be on my way getting help. I'm also taking double the 81 mg aspirin for now. I take it at about 10:00 PM and again at 2:00 AM. The does is so small, I just decided that as well. I want to wake up with thinned blood. Also take the Pred at 2:00 AM. Want to have the Pred up and going strong when I wake up. Hope that these techniques will lessen the potential for the dreaded morning eye problem. My brain does not seem to have been affected, nor do I have stroke-like weakness. Will let everyone know as the saga continues. Thanks for all your help and always the great encouragement.

[PJPS]

Hi Asbeck, I was only diagnosed with PMR in Dec 2014, but I experienced Amaurosis fugax 3 years ago and it frightened the life out of me. PMRpro explained it brilliantly, I had tests done within days and the results came back as idiopathic, they couldn't find anything wrong, however, I've been on statins and clopidogrel as preventive medication ever since.

Good luck with everything.

[Asbeck in reply to PJPS]

Thank you PJPS. Hope that I follow in your foot steps. Also thank you for the good luck wishes.

[Asbeck]

OK everybody PMRpro, Pascua and PJPS: The eye doctor wrote on my chart: "Amaurosis Fugax on account of "change in arterial occlusion of retina." I had an ultrasound of my carotid arteries. Then he wrote regarding the ultra sound: "No hemodynamic significant stenosis seen." This seems good. He said something about artherosclerotic.... There is an association between GCA and atherosclerosis. Some think that we have this and the antibodies attack where we have it. Others think that the attacks leave injured tissue which then gets coated with the plaque. I'm of the latter attitude. I only had it in the bad temporal artery and not in the good one. I know that I acquired GCA around April of 2012 and PMR around August of 2012. Diagnosed around October 2012. My Rheumy says no problem in looking at my larger arteries now. I'll see her in May and get an appointment to get that done. I know that I've got something in my right arm. I get rushes of heat on the inside of the arm where my elbow bends and a sensation in the artery in my palm under my baby finger. And that finger hurts and doesn't want to bend in the hours before I take the Prednisone. That might be something like a subclavian artery problem. I also had it horribly near the right shoulder in late Sept. 2012. The entire arm didn't want to work. (Found some old Prednisone. had figured out by that time that Pred for some reason really worked.) I guess that I'll keep trying to figure it out. Hope that this helps someone. I'll report back in May or June in case the scans help someone else. Thanks for all your help.