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Transient visual loss in a 60-year-old man.
Jacqueline M S Winterkorn1, Prinze Mack, Eric Eggenberger
1Department of Ophthalmology, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA. JMSWinte@aol.com <JMSWinte@aol.com>
Survey of Ophthalmology
|May 27, 2008
Summary
A lupus anticoagulant caused recurrent transient vision loss in a patient. Prompt diagnosis and anticoagulation therapy prevented further permanent visual loss.
Area of Science:
- Ophthalmology
- Neurology
- Hematology
Background:
- Recurrent amaurosis fugax, or transient vision loss, can indicate underlying embolic or thrombotic events.
- Identifying the source of transient ischemic attacks is crucial for preventing permanent neurological deficits.
Observation:
- A 60-year-old male presented with a 5-year history of episodic, transient vision loss.
- A recent episode resulted in permanent visual loss, prompting further investigation.
Findings:
- Standard imaging (CT, MRI) and vascular studies (transesophageal echocardiogram, carotid duplex) did not reveal embolic sources.
- Laboratory tests identified a lupus anticoagulant, indicated by elevated activated partial thromboplastin time (APTT) unresponsive to dilution.
Implications:
- Lupus anticoagulant is a significant risk factor for arterial and venous thrombosis, including retinal artery occlusion.
- Anticoagulation therapy, including warfarin and aspirin, effectively managed the condition and prevented recurrence of vision loss.
- This case highlights the importance of investigating hypercoagulable states in patients with unexplained transient ischemic events affecting vision.
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