Cerebrovascular imaging of carotid embolization: Amaurosis fugax and transient ischemic attack in motion

TL;DR

A doctor recorded his own eye blood flow during a vision loss episode, revealing a rare carotid embolism event and leading to successful treatment.

Contribution

Real-time documentation of embolus migration in a patient with high-grade carotid stenosis using self-recorded imaging.

Findings

A 65-year-old patient captured embolus migration in the ophthalmic artery during transient monocular vision loss.

Duplex ultrasound showed over 90% stenosis in the left internal carotid artery with high velocity measurements.

Carotid endarterectomy was performed successfully, preventing further cerebrovascular events and vision loss.

Abstract

We describe a 65-year-old male ophthalmologist who experienced a brief episode of transient monocular vision loss in his left eye, characterized as a “gray-out” lasting a few seconds. Utilizing his medical expertise, the patient recorded the blood flow in his ophthalmic artery, capturing a rare real-time visualization of embolus migration from the central to peripheral regions. The embolism resolved spontaneously, restoring normal vision. Duplex ultrasound revealed high-grade stenosis in the proximal left internal carotid artery, with a peak systolic velocity of 421 cm/s and an end-diastolic velocity of 188 cm/s, consistent with over 90% stenosis. A computed tomography angiogram confirmed the presence of an ulcerated plaque, attributing the vision loss to emboli originating from the carotid artery. Because of the critical stenosis and risk of further cerebrovascular events, a semiurgent left carotid endarterectomy was performed under regional anesthesia. The procedure was completed without complications, and the patient’s vision remained normal postoperatively. This case highlights the unique real-time documentation of an embolic event in an ophthalmologist who recognized the pathophysiology, emphasizing the importance of timely diagnosis and intervention, particularly carotid endarterectomy, in preventing stroke and irreversible vision loss in patients with high-grade internal carotid artery stenosis.

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