An 83-year-old Caucasian man comes to the emergency department because of a sudden onset, transient visual loss in his right eye. He is currently symptom-free, and denies any other new symptoms. His other medical problems include hypertension and peripheral vascular disease. His medications include aspirin, hydrochlorothiazide, and enalapril. His temperature is 36.7 C (98 F), blood pressure is 160/90 mmHg, pulse is 80/min., and respirations are 12/min. Which of the following signs is most likely to be associated with his symptoms/condition?

Question

An 83-year-old Caucasian man comes to the emergency department because of a sudden onset, transient visual loss in his right eye.  He is currently symptom-free, and denies any other new symptoms.  His other medical problems include hypertension and peripheral vascular disease.  His medications include aspirin, hydrochlorothiazide, and enalapril.  His temperature is 36.7 C (98 F), blood pressure is 160/90 mmHg, pulse is 80/min., and respirations are 12/min.  Which of the following signs is most likely to be associated with his symptoms/condition?

Quizplus · Accepted Answer

Explanation: This patient has developed amaurosis fugax, an acute ischemic event involving the retinal artery. This condition is sudden and usually reversible. It is a marker of carotid artery atherosclerotic disease. A carotid bruit on auscultation of the neck is a very frequent finding; this indicates a significant carotid obstruction. (Choice B)A diastolic heart murmur can be a marker of aortic insufficiency or mitral stenosis. Both conditions are related to ischemic cerebrovascular accidents (CVA). Although these could occur, this elderly patient's transient symptom is more likely to be concurrent with findings suggestive of carotid artery disease. (Choice A)Conditions producing systolic heart murmurs such as mitral regurgitation, aortic stenosis, or tricuspid regurgitation, are more related to heart failure symptoms. Even though aortic stenosis can be related to syncope, it does not cause amaurosis fugax . (Choice D)Acute retinal vein thrombosis can be diagnosed by fundoscopy,when extensive hemorrhage is seen in the retina. It will not present as amaurosis fugax. (Choice C)Papilledema is seen as a result of increased intracranial pressure. Pseudopapilledema, on the other hand, may be seen in an established nerve damage or in optic neuritis, but not in amaurosis fugax. Ischemia will manifest as disc paleness, not papilledema, especially in a transient event. Educational objective: Amaurosis fugax is a sudden and transient monocular blindness. Even though it is reversible, it is a marker of carotid artery atherosclerotic disease that is usually advanced. Physical examination will often reveal a carotid bruit. Carotid Doppler evaluation is necessary to evaluate the extent of the disease and to assess the need for a carotid endarterectomy.

An 83-Year-Old Caucasian Man Comes to the Emergency Department Because