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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3164
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I loss vision in my right eye for 2min, 10 days..ultra sound

Customer Question

Hello, I am a 55 yr old, female. I loss vision in my right eye for 2min, 10 days ago, it went totally black, with no pain and no activities that would set it off. I had an echogram and carotid ultra sound via my cardiologist. I have a artificial aorta valve(4yrs ago) and he was of course concerned about clots. the tests came back normal. My coumidin levels are within range. I have no blood pressure issues. My eye doctor chose not see me, and suggested embolic workup and a sed rate test, which my cardio did not follow through on. I am still upset with this happening and want to seek further tests. whats next for me?
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 4 years ago.
Chat Conversation Started
Doctor DanB :

Hello and thanks for your question. I can certainly understand your angst. Have you been having any headaches, cramping in your jaw when you chew your food, or tenderness in your scalp?

Customer:

no not at all

Doctor DanB :

Did you have any shimmering lights in your vision associated with this vision loss? How about noticeable irritability, nausea, sensitivity to bright lights or loud noises?

Customer:

none of the above,

Doctor DanB :

Can you please describe for me how your vision went black. How long did it take from the moment you realized something was happening until it went completely out? Did the vision just gradually fuzz out, or did it seem as though a curtain was being drawn over your vision?

Customer:

curtain, took less than 10 seconds, and returned the same way. absolute blackness.

Doctor DanB :

What were the results of the echocardiogram and the carotid ultrasound?

Customer:

normal

Doctor DanB :

I assume the echocardiogram was performed with the probe placed on your chest as opposed to a camera/tube down your throat, is that correct?

Customer:

I have an echo done yrly due to my artificial aorta valve, last one was Dec 09,this echo was same result, no changes. yes probe on chest.

Doctor DanB :

Have you been having fevers, chills, weight loss or night sweats? How about episodes of double vision or changes in vision otherwise?

Customer:

none of the above

Customer:

are you there?

Doctor DanB :

There are two entities that should be addressed, both of which could cause the symptoms you have described. One of them is an inflammation of blood vessels called Giant Cell Arteritis or Temporal Arteritis. This inflammation of blood vessels can cause catastrophic medical problems to include blindness, strokes and heart attacks. Fortunately, through your history, it does not sound likely, but that doesn't rule it out. For this reason, drawing the ESR (erythrocyte sedimentation rate) and a C-reactive protein (CRP) would shed some light on this. If both of these tests are stone cold normal, then the chances of this being from Giant Cell Arteritis are next to none. Second, this could be due to a cardioembolic phenomenon. Classical causes of emboli that could end up in the circulation for the eye include the carotid arteries and the heart. Since you have an artificial aortic valve, that is a prime suspect. Also, even though the carotid ultrasound may have been "normal", this interpretation by a radiologist would likely be framed in the light of near-complete occlusion of the inside of the blood vessel versus atherosclerotic disease (cholesterol) that was there, but not in any danger of closing off. That is usually the reason why a carotid ultrasound is done, to determine whether there is a distinct chance of the vessel closing off. In your case, even if the vessel is 50% occluded with cholesterol plaque, it may still be a viable source of a clump of cholesterol breaking off and making its way to the arterial circulation of the eye, even though the carotid artery would be "normal" from the standpoint of not being close to occlusion. For this reason, I think there are two things which potentially should be done. First, a dilated retinal examination by an ophthalmologist is a good idea because if there are embolic plaques that are seen in the blood vessels in the retina, then this could give a clue as to the origin of the plaque and direct the workup in a more circumspect fashion--these plaques are not always or even commonly seen in these exams, but they can be seen in some. Second, the other test to consider doing to rule out a possible vegetation or valve problem would be a trans-esophageal echocardiogram, which involves putting a camera-tube down the throat to get a closer and more sensitive view of the heart--it may provide a better view of the heart valve. Otherwise, I think that the other things that have been done have been right, with the exception of having the dilated retinal examination.

Doctor DanB :

Sorry; it took me a while to type all of that.

Customer:

yes I figured you were typing but wanted to make sure we didnt loose the connection. Well, thank you, XXXXX XXXXX will give me knowledge to take further steps, I did not know what to ask of my doctors, now I have an idea. What about brain tumors?

Doctor DanB :

Brain tumors usually do not cause this type of transient visual loss which is termed amaurosis fugax. While anything is possible in medicine, I would not suspect that at all.


Does that address your concern?


 


I am happy to be able to help you today. If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter. I would also be happy to continue to answer any more questions you have until we have resolved your concern.



Also, any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated.



My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must be examined by your doctor.

Customer:

but it wouldn't hurt to have a brain scan, what would that term be called. just to satisfy my concern. Its quite frightening to have this happen, obviously I have been through alot, but this scared me more than open heart surgery(although I had that done at the expert hands of Dr. Lax in UCLA)

Customer:

I have to leave now. thanks and I will click on accept:)

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3164
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Dr. Dan B. and other Eye Specialists are ready to help you
Expert:  Dr. Dan B. replied 4 years ago.

Sorry, the chat feature on this system does not always show me all of your responses and so I missed your last two statements until now. I think having a scan of your brain would be reassuring at least and given the paucity of results explaining this amaurotic event, may even be considered a reasonable next step. There are two types of scans that one might have in this situation. The first might be a CT scan of your brain, or also called a CAT scan, or computed tomographic scan--it is an xray that displays the brain in slices. It is a good test to delineate large mass lesions, hemorrhaging and bony defects. Since what may be causing this may be more subtle, the more appropriate brain scan test would likely be an MRI of the head and orbits. This would show more subtle neurologic detail which would be needed to identify possible small lesions that may be at play here.

 

Hope that helps.

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