Giltner John W, Thomas Edward R, Rundell William K
Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
Ohio Eyecare Institute, Premier Health Specialists, Dayton, OH, USA.
Int Med Case Rep J. 2016 Jul 4;9:169-72. doi: 10.2147/IMCRJ.S106627. eCollection 2016.
A 68-year-old female with no significant past medical history presented with loss of vision in the lower half of her left eye that lasted <5 minutes. No abnormalities were found on ocular or physical exam. Computed tomography angiography and carotid ultrasound were performed, which confirmed the diagnosis as amaurosis fugax with two abnormalities leading to the transient retinal vessel occlusion. First, it was found that the patient has a congenital vascular anomaly, which consisted most notably of a right-sided aortic arch. This vascular anomaly also consisted of abnormal branching of the left subclavian and common carotid arteries, predisposing the patient to turbulent blood flow and increased risk of the formation of an atherosclerotic plaque at the origin of the common carotid artery. This is an abnormal location for a plaque leading to amaurosis fugax compared to the most common location at the carotid bifurcation. Endarterectomy was not performed because of the difficult location of the plaque and tortuosity of the vessel. Rather, medical intervention with antiplatelet and lipid-lowering therapy was initiated to lower the risk of future retinal or cerebral thromboembolic events.
一名68岁女性，既往无重大病史，出现左眼下半部分视力丧失，持续时间小于5分钟。眼部及体格检查未发现异常。进行了计算机断层血管造影和颈动脉超声检查，确诊为一过性黑矇，有两个异常导致短暂性视网膜血管阻塞。首先，发现患者有先天性血管异常，最显著的是右侧主动脉弓。这种血管异常还包括左锁骨下动脉和颈总动脉分支异常，使患者易于出现血流紊乱，并增加颈总动脉起始处形成动脉粥样硬化斑块的风险。与最常见的颈动脉分叉处相比，导致一过性黑矇的斑块在此处位置异常。由于斑块位置困难且血管迂曲，未进行动脉内膜切除术。相反，启动了抗血小板和降脂治疗的医学干预措施，以降低未来视网膜或脑血栓栓塞事件的风险。
