Yield of Investigations in Young Patients Presenting with Transient Monocular Vision Loss

Transient monocular vision loss (TMVL) in older patients warrants thorough work-up including investigation for potential embolic sources with imaging of the carotid circulation and cardiac evaluation. In young patients with lower risk for atherosclerosis, arrhythmias, and cardiac disease, it is unclear whether the same approach should be used. The objective of the present study was to evaluate the yield of investigations in patients under 45 years old presenting with TMVL. This was a retrospective cohort study of 22 patients with TMVL presenting to a neuroophthalmology clinic. We collected information on demographics, ophthalmic investigations, neuroimaging, cardiac investigations, and laboratory findings.

Poster 93 Yield of Investigations in Young Patients Presenting with Transient Monocular Vision Loss Laura Donaldson 1, Irina Sverdlichenko 2, Edward Margolin 3 1 McMaster University, 2 Temerty Faculty of Medicine, 3 University of Toronto Introduction: Transient monocular vision loss (TMVL) in older patients warrants thorough work-up including investigation for potential embolic sources with imaging of the carotid circulation and cardiac evaluation. In young patients with lower risk for atherosclerosis, arrhythmias, and cardiac disease, it is unclear whether the same approach should be used. The objective of the present study was to evaluate the yield of investigations in patients under 45 years old presenting with TMVL. This was a retrospective cohort study of 22 patients with TMVL presenting to a neuroophthalmology clinic. We collected information on demographics, ophthalmic investigations, neuroimaging, cardiac investigations, and laboratory findings. Description of Cases: The mean age of participants was 33.0 ± 7.9 years and 81.8% (8/22) were women. The most common finding on past medical history was migraines, at 22.7% (5/22). Ophthalmic examination revealed abnormal findings in 22.7% of participants, including visual field defects, ganglion cell loss and chorioretinal atrophy. None of the patients demonstrated carotid stenosis on angiography, however one patient had evidence of fibromuscular dysplasia of the ipsilateral internal carotid artery. Of 11 patients who had an MRI, 2 (18.2%) showed cerebral diffusion restriction. ECG was abnormal in 30.0% (3/10) of patients and on echocardiogram 28.6% (2/7) were found to have a patent foramen ovale. One patient with cardiomyopathy received an implantable cardioverter defibrillator, while four other patients were started on Aspirin therapy. Conclusions, including unique features of the case: In young patients presenting with TMVL, the rate of significant abnormal investigations ranged from 5-18% on neuroimaging for fibromuscular dysplasia and diffusion restriction respectively, to 28% on cardiac investigations for patent foramen ovale. Thus, young patients presenting with TMVL may need workup to identify embolic causes of their visual symptoms and prevent poor outcomes. References: None provided. Keywords: Neuroimaging, Visual fields, Miscellaneous Financial Disclosures: The authors had no disclosures. Grant Support: None Contact Information: Irina Sverdlichenko, [e-mail] 2023 Annual Meeting Syllabus | 157