All 7
patients had 3 or more positive ACR criteria. In all but one patient, fundoscopic examination demonstrated AION with a blurred rim of the optic disc with optic disc edema and hyperemia with see more or without small splinter hemorrhages ( Fig. 1d). One patient had findings equivalent to CRAO, the diagnosis of TA was validated years before on the basis of ACR criteria by the Department of Rheumatology. In 3 of the 7 patients we found a halo sign in the ipsilateral and/or contralateral superficial temporal artery during the ultrasound examination. The diagnosis was confirmed in 4 of 7 patients by means of temporal artery biopsy. In 1 patient, who was unable to undergo biopsy because of ongoing anticoagulation therapy with warfarin, a positive “halo” sign was identified in the left temporal artery. One patient had 4 out of 5 positive ACR-criteria but a negative finding in temporal artery biopsy. None of the patients in this group had a retrobulbar spot sign, but there was absent or pseudovenous flow in the CRA (Fig. 1a–c). Arterial hypertension was present in 4 patients, diabetes mellitus in 2 patients, hypercholesterolemia in 1 patient, and atrial fibrillation (AFIB) in
a single patient who was treated with warfarin accordingly. One patient was a former smoker. The average number of risk factors per patient in this group was 2. Group 2: 17 patients (8 male and 9 female) had sudden monocular blindness based on other pathologies than TA. 12 patients had CRAO in funduscopy. In 2 female patients we found typical fundoscopic findings of anterior ischemic optic neuropathy (AION). One male patient had small splinter hemorrhages in funduscopy Selleck PI3K Inhibitor Library but normal flow in both CRAs, probably as a result of recanalized CRAO. One male patient
had an occlusion of a big retinal artery (CRA branch) with absent flow in the CRA, based on an ipsilateral ICA occlusion with collateralization from the contralateral ICA. One male patient with risk factors of hypertension, former tobacco use, and hyperuricemia, had a 90% stenosis (graded according to ECST criteria [10]) in the left ICA and visual loss in the left eye due to hypoperfusion of the left CRA; he was referred to vascular surgeons for carotid endarterectomy. All of these patients had Etofibrate a maximum of 2 positive ACR criteria. On OCCS 10 (59%) of 17 patients had a visible hyperechoic plaque, known as “spot sign,” at the tip of the CRA; taken in account only the patients with CRAO in funduscopy in this group, 10 of 12 patients (83%) had a visible “spot sign” and absent arterial flow (Fig. 2a and b). Moderate ipsilateral ICA stenosis (50–60% according to ECST criteria) was present in three patients (27%) and an additional 3 patients had contralateral ICA stenosis. The average number of risk factors per patient in this group was 2.2. Arterial hypertension was present in 14 patients, AFIB in 2 and hypercholesterolemia in 7.