Retinal Emboli

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Identifier 016-1
Title Retinal Emboli
Creator Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Contributor Primary Shirley H. Wray, MD, PhD, FRCP, Professor of Neurology, Harvard Medical School; Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Subject Retinal Emboli; Transient Monocular Blindness; Ocular Stroke; Transient; Transient Visual Loss
Supplementary Materials PowerPoint Presentation: Transient Monocular Blindness: http://library.med.utah.edu/NOVEL/Wray/PPT/Transient_Monocular_Blindness_guest_lecture.ppt Shirley H. Wray, M.D., Ph.D., FRCP, Harvard Medical School
Presenting Symptom Transient monocular blindness
History Temporary loss of vision in one eye, termed transient monocular blindness (TMB), is the most important visual symptom of arteriosclerotic vascular disease, arteritis and states of altered coagulability and thrombocytosis. In most patients, the visual disturbance during each individual attack of TMB is stereotypic. It may recur over a period of months or over a much briefer span of hours, days, or weeks. A meticulous history of the attack and duration of the visual disturbance will permit classification of the TMB occurrence into one of four types. Type I is due to transient retinal ischemia. Type II is due to retinal vascular insufficiency. Type III is due to vasospasm. Type IV occurs in association with antiphospholipid antibodies, but includes cases of unknown cause. (Wray SH.Table 7-1 (10)). (Review ID937-2).
Clinical A unique film of retinal emboli passing through the microcirculation of the retina recorded by Roger Lancaster (photographer) in 1967 with Dr. Cogan and his two fellows, Dr. Philip Zweifach and Dr. David Haining, is shown here. I believe this is the only film in existence showing moving emboli in branches of the central retinal artery. A retinal embolus is virtually diagnostic of localized disease of the ipsilateral internhal carotid artery (ICA) when a typical carotid bruit is present, when aortic or cardiac disease is absent, and when there is no exogenous source of emboli, as, for example, intravenous drug use (talc and microcrystalline cellulose), severe trauma, or injection (air). Cholesterol emboli (Hollenhorst plaques) appear in the branches of the central retinal artery as bright or shiny bodies whose diameter seems to exceed the intraluminal diameter of the arteriole. These emboli tend to lodge at arterial bifurcations. They may be invisible except on ocular compression or by varying the incidence angle of the ophthalmoscope light. They may be permanent or quite transient, moving on to the next bifurcation or disappearing before the next examiner can verify them. The presence of a cholesterol embolus is a poor prognostic sign: 93% of such patients have vascular disease at presentation; 15% die within the first year and 55% within 7 years. The cause of death is usually heart disease, 6:1 compared with stroke. Pale white platelet plugs can also be seen transiently within retinal arteries. In a hypertensive patient, the caliber of the retinal arteries on the side of an ICA stenosis may be reduced and will show fewer hypertensive changes than the retinal vessels of the opposite eye. Focal cotton-wool spots (cystoid bodies), in the absence of hypertensive retinopathy, are due to embolic microinfarction and may be seen when no emboli are visible.
Disease/Diagnosis Transient Monocular Blindness; Retinal Emboli
References Beal MF, Williams RS, Richardson EP , Fisher CM. Cholesterol embolism as a cause of transient ischemic attacks and cerebral infarction. Neurology 1981;31:860-865. http://www.ncbi.nlm.nih.gov/pubmed/7195508 Burde RM. Amaurosis fugax, an overview. J Clin Neuroophthalmol 1989;9:185-189. http://www.ncbi.nlm.nih.gov/pubmed/2529279 Cogan DG, Wray SH. Vascular occlusions in the eye from cardiac myxomas. Amer J Ophthalmol 1975; 80:396-403. http://www.ncbi.nlm.nih.gov/pubmed/1163587 Fisher CM. Transient monocular blindness associated with hemiplegia. Am Arch Ophthalmol 1952; 47:167-203. http://www.ncbi.nlm.nih.gov/pubmed/14894017 Fisher CM. Observations of the fundus oculi in transient monocular blindness. Neurology 1959; 9:333-347. http://www.ncbi.nlm.nih.gov/pubmed/13657292 Hollenhorst RW. The ocular manifestations of internal carotid arterial thrombosis. Med Clinics N. America 1960;44:897-908. http://www.ncbi.nlm.nih.gov/pubmed/14402672 Hollenhorst RW. Significance of bright plaques in the retinal arterioles. J Amer Med Assoc 1961;178:123-129. http://www.ncbi.nlm.nih.gov/pubmed/13908419 Savino PJ, Glaser JS, Cassady J. Retinal stroke: Is the patient at risk? Arch Ophthalmol 1977;95:1185-1189. http://www.ncbi.nlm.nih.gov/pubmed/880077 Wray SH. Extracranial internal carotid artery disease. In: Amaurosis Fugax, Ed. E.F. Bernstein. New York: Springer-Verlag 1988;72-80. Wray SH. Visual Symptoms. Ch 7, 66-79. In: Stroke Syndromes. Ed. Bogousslavsky J., Caplan L. Cambridge University Press, 2nd Edition. 2001;111-128.
Relation is Part of 937-2
Contributor Secondary Ray Balhorn, Video compressionist
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Type Image/MovingImage
Format video/mp4
Source 16 mm Film
Rights Management Copyright 2002. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s628354w
Setname ehsl_novel_shw
Date Created 2007-08-09
Date Modified 2017-11-22
ID 188607
Reference URL https://collections.lib.utah.edu/ark:/87278/s628354w