Скачать или смотреть Amaurosis Fugax 👁️ Internal Medicine Neurology/Ophthalmology | USMLE Step 2 CK

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Amaurosis Fugax 👁️ Internal Medicine Neurology/Ophthalmology | USMLE Step 2 CK

Amaurosis fugax is defined as a transient, painless, monocular vision loss lasting from seconds to minutes, caused by transient retinal ischemia. It is often described by patients as a “curtain descending over the eye” that lifts after a brief period. This phenomenon is considered the ocular equivalent of a transient ischemic attack (TIA) and is a critical warning sign for an impending stroke, particularly in patients with carotid artery disease or cardioembolic risk factors such as atrial fibrillation. The most common underlying mechanism is embolization from an atherosclerotic plaque in the ipsilateral internal carotid artery, which temporarily blocks blood flow to the retina through the central or branch retinal artery. Less commonly, it may be caused by vasculitis (notably giant cell arteritis in the elderly), cardiac emboli, hypercoagulable states, or ophthalmic artery vasospasm.

Risk factors include hypertension, diabetes, hyperlipidemia, smoking, atherosclerosis, and cardiac arrhythmias. In elderly patients, giant cell arteritis must be considered and ruled out urgently, especially if the patient reports jaw claudication, scalp tenderness, or systemic symptoms.

Evaluation of amaurosis fugax includes carotid Doppler ultrasound to detect carotid artery stenosis, ECG and echocardiography to assess for cardiac embolic sources, and ESR and CRP to screen for temporal arteritis. An urgent ophthalmologic examination is indicated, and fundoscopy may reveal Hollenhorst plaques, which are bright cholesterol emboli lodged in retinal arterioles.

Management focuses on preventing a full-blown stroke. Patients with significant carotid stenosis (greater than 70 percent) benefit from carotid endarterectomy. All patients should be started on aspirin, high-intensity statins, and receive blood pressure optimization. If giant cell arteritis is suspected, high-dose corticosteroids should be initiated immediately, even before biopsy confirmation, to prevent permanent vision loss.

On USMLE Step 2 CK, amaurosis fugax may appear as a case scenario where a patient reports brief monocular vision loss, particularly with a history of vascular risk factors. Be ready to order the correct imaging and labs, recognize the vascular urgency, and implement stroke prevention strategies quickly and appropriately.

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