title: Ischemic optic neuropathy associated with internal carotid artery dissection.
abstract: BACKGROUND
  Ischemic optic neuropathy (ION) is an infarction of the anterior or, less frequently, posterior part of the optic nerve, usually due to a disease of small arteries supplying the optic nerve. Carotid stenosis or occlusions are rare causes, and among them, carotid dissections have been so far reported in only 5 cases.
  
  
  METHODS
  We describe 4 patients with ION (2 anterior and 2 posterior) due to internal carotid artery dissection of a consecutive series of 110 patients with internal carotid artery dissection (3.6%).
  
  
  RESULTS
  None of the patients had signs of central retinal artery occlusion or ischemic ocular syndrome. Ischemic optic neuropathy occurred after a mean of 5.3 days (range, 3-8 days) following the first symptom, which was headache in 1 patient, transient monocular blindness in 2, and hemispheric transient ischemic attack in 1. One patient had associated Homer syndrome, and 2 had severe ipsilateral headache and orbital pain. None of the patients developed a cerebral infarction. These features differ from those observed in "classic" nonarteritic anterior ION and might therefore point to carotid dissection.
  
  
  CONCLUSIONS
  Ischemic optic neuropathy may occur as an early sign of carotid dissection: young age, previous transient monocular blindness, an association with pain, Horner syndrome, or hemispheric transient ischemic attacks are suggestive of this cause and should prompt confirmatory investigations.
authors.affiliation: Department of Neurology, Hôpital Lariboisière, Paris, France. biousse@ccr.jussieu.fr
authors.forename: V
authors.initials: V
authors.lastname: Biousse
authors.forename: M
authors.initials: M
authors.lastname: Schaison
authors.forename: P J
authors.initials: PJ
authors.lastname: Touboul
authors.forename: J
authors.initials: J
authors.lastname: D'Anglejan-Chatillon
authors.forename: M G
authors.initials: MG
authors.lastname: Bousser
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications*; D002340:Carotid Artery Diseases / Q000150:complications*; D002343:Carotid Artery, Internal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000150:complications*; D011446:Prospective Studies; D012189:Retrospective Studies