J Korean Ophthalmol Soc.  2016 Sep;57(9):1484-1488. 10.3341/jkos.2016.57.9.1484.

Amaurosis Fugax Associated with Ipsilateral Internal Carotid Artery Agenesis

• Sung JY
• Kim KN
• Jeong HS
• Lee YH

• KMID: 2351883
• DOI: http://doi.org/10.3341/jkos.2016.57.9.1484

Abstract

PURPOSE
We report a case of amaurosis fugax associated with ipsilateral internal carotid artery agenesis.
CASE SUMMARY
A 50-year-old woman presented with amaurosis fugax in her left eye; the frequency of episodes of the condition had recently increased to once a month. She had a history of hypertension and dyslipidemia, and was under medical therapy. The visual acuity of both eyes was 20/20. Slit-lamp examination was normal except for pseudophakia. Ophthalmoscopy revealed a myopic tigroid fundus and a myopic tilted disc. No abnormalities were evident in fluorescein fundus angiography. Brain computed tomography showed that the left bony carotid canal was absent, and magnetic resonance angiography showed that the left internal carotid artery was also absent. She was diagnosed with left internal carotid artery agenesis. Other neurological and hematological parameters were within normal ranges. The amaurosis fugax spontaneously disappeared and has not recurred over the past 12 months. Our case, although rare, suggests that amaurosis fugax may be associated with internal carotid artery agenesis.

Keyword

Agenesis; Amaurosis fugax; Internal carotid artery

MeSH Terms

Amaurosis Fugax*
Angiography
Blindness*
Brain
Carotid Artery, Internal*
Dyslipidemias
Female
Fluorescein
Humans
Hypertension
Magnetic Resonance Angiography
Middle Aged
Ophthalmoscopy
Pseudophakia
Reference Values
Visual Acuity
Fluorescein

Figure

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  Figure 1. Fundus photographs of the both eyes. Both eyes show myopic tigroid fundus and myopic tilted disc with peripapillary atrophy.

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  Figure 2. Fluorescein fundus angiography of the left eye. (A) Retinal artery filling was started at 10 seconds after injection of the sodium fluorescein dye into the antecubital vein. (B) Retinal vein filling was completed at 18 seconds after injection.

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  Figure 3. Magnetic resonance imaging (MRI) and computed tomography (CT). (A) MRI and (B) CT of the skull base showing a carotid canal on the right (arrows), but absent on the left.

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  Figure 4. Magnetic resonance angiography (MRA). (A) MRA reveals the right internal carotid artery (arrow) and the absence of the left internal carotid artery. (B) At the circle of Willis, the left middle cerebral artery and anterior cerebral artery (arrowheads) are filled via posterior communicating artery (arrow).

Reference

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