J Korean Ophthalmol Soc.  2010 May;51(5):779-783.

Valsalva Maneuver-induced Amaurosis Fugax

• Jo YJ
• Yun YJ
• Kwag JY
• Kim JY

Abstract

PURPOSE
To report the case of a patient with amaurosis fugax that occurred following a Valsalva maneuver.
CASE SUMMARY
A 40-year-old man presented with amaurosis fugax of the right eye, which had occurred several times during the previous month. After coughing, the visual acuity of the right eye decreased temporarily during the first episode. Subsequently, any time a Valsalva maneuver, such as coughing, occurred, this symptom reappeared. Initially, this symptom persisted for five to ten minutes and occurred once or twice a day, but it gradually increased in frequency. The physical examination was normal, and his best corrected visual acuity was 20/20 bilaterally. Neither specific findings in the slit lamp examination nor abnormal findings in the fundus examination were detected. On fluorescein fundus angiography, no abnormal finding was observed before the symptom was triggered by a Valsalva maneuver, but after the symptom was triggered by coughing, the choroidal and retinal arterial phases were delayed. Hematological and neurological examinations, including magnetic resonance imaging, magnetic resonance angiography, and cerebral angiography, were all normal. Therefore, he was diagnosed with amaurosis fugax generated by a Valsalva maneuver.
CONCLUSIONS
In any patient who complains of amaurosis fugax repeatedly, as seen in this case, one must consider the possibility that it results from a Valsalva maneuver, after eliminating occlusive vascular diseases, such as carotid stenosis or atherosclerotic disease.

Keyword

Amaurosis fugax; Valsalva maneuver

MeSH Terms

Adult
Amaurosis Fugax
Angiography
Blindness
Carotid Stenosis
Cerebral Angiography
Choroid
Cough
Eye
Fluorescein
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Neurologic Examination
Physical Examination
Retinaldehyde
Valsalva Maneuver
Vascular Diseases
Visual Acuity
Fluorescein
Retinaldehyde

Figure

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  Figure 1. (A) Fundus photographs of the patient. During an asymptomatic period. (B) During acute attack of symptoms by Valsalva maneuver. There is no difference in the fundus finding observed before and after symptom.

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  Figure 2. Fluorescein fundus angiography of the right eye. (A) During an asymptomatic period, filling of the retinal artery was completed at 20 seconds after injection. (B) filling of the retinal vein was completed at 32 seconds after injection. (C) During an attack of symptom by valsalva maneuver, filling of the retinal artery was started at 28 seconds after injection. (D) filling of the retinal artery was still incomplete at 40 seconds after injection.

Reference

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