Vasospastic Amaurosis Fugax Diagnosed by Cerebral Angiography.
We report a case of recurrent monocular blindness presumed to be caused by vasospasm, demonstrated by digital subtraction angiography.


METHODS
A 65-year-old man presented with recurrent visual loss in the left eye for 2 years. He had histories of hypertension, cigarette smoking, and May-Thurner syndrome. The symptom occurred variably from twice a day to once a week and usually lasted for 5 minutes. Brain magnetic resonance imaging, magnetic resonance angiography, and ophthalmologic evaluation did not reveal any abnormality. Cerebral digital subtraction angiography was performed. On the left internal carotid angiogram, vasospasm occurred in the cervical portion of the left internal carotid artery and, subsequently, the blood flow to the left ophthalmic artery diminished. This phenomenon was reproducible and, in the absence of vasospasm, the ophthalmic artery was well visualized with no steno-occlusive lesion. Examination of the carotid duplex showed diffuse luminal narrowing and increased flow velocities in the left cervical internal carotid artery without atherosclerotic plaque. Treatment was started with nimodipine, which markedly reduced the attacks.


CONCLUSIONS
We assumed that vasomotor instability, which made the vessels vulnerable to spasm, may have caused a recurrent ocular symptom in our patient.
Busan-Ulsan Regional Cerebrovascular Center, Dong-A University Hospital, Busan, South Korea.
Dong-Hyun
DH
Shim
Busan-Ulsan Regional Cerebrovascular Center, Dong-A University Hospital, Busan, South Korea.
Jae-Kwan
JK
Cha
Busan-Ulsan Regional Cerebrovascular Center, Dong-A University Hospital, Busan, South Korea.
Myung-Jin
MJ
Kang
Busan-Ulsan Regional Cerebrovascular Center, Dong-A University Hospital, Busan, South Korea.
Jae-Hyung
JH
Choi
Busan-Ulsan Regional Cerebrovascular Center, Dong-A University Hospital, Busan, South Korea. Electronic address: hyunwook.nah@gmail.com.
Hyun-Wook
HW
Nah
D000368:Aged; D020757:Amaurosis Fugax / Q000175:diagnosis* / Q000209:etiology; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods*; D006801:Humans; D008297:Male; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging; D020301:Vasospasm, Intracranial / Q000150:complications
Amaurosis fugax; Calcium-channel blocker; Cerebral angiography; Vasospasm