History

Fact Explanation
Risk factors for stroke or ischemic heart disease. The patients presenting with amaurosis fugax (as follows) are almost predicted to have a stroke syndrome, ischemic heart disease and a high predicted mortality rate, since the statistical relationship between them is linked too closely as un-earthed by studies done over years. [1], [2], [3], [4] The underlying reason for this is amaurosis is due to retinal vascular occlusion, which is one manifestation of various vascular occlusive disorders.
Middle age man It's more common in middle age patients, or elderly patient and mostly prevalent in the male sex. But younger patients, below 40 years with amaurosis fugax have been studied. [5]
Sudden loss of vision It's due to occlusion of one or more arteries that supplies the retinal bed and resultant ischemia. The retinal artery, ophthalmic artery and ciliary artery are end arteries, so blockage results in prompt ischemia. The causes can be divided as embolic, hemodynamic, ocular, neurologic, and idiopathic. But the commonest is atherosclerosis in the carotid artery and resultant thrombo-embolism. The visual loss can be unilateral or bilateral, and can last for seconds to minutes. The impairment progressively may involve the entire visual field. The loss of vision usually begins in the upper field, less frequently in the periphery, and rarely in the lower field. It also can be patchy or homogeneous. It can be repetitive, in those cases the patients may complain about having previous episodes. [6], [7], [8], [9], [11], [12], [13], [14]
References
  1. POOLE CJ, ROSS RUSSELL RW. Mortality and stroke after amaurosis fugax. J Neurol Neurosurg Psychiatry [online] 1985 Sep, 48(9):902-905 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1028491
  2. HOWARD RS, RUSSELL RW. Prognosis of patients with retinal embolism. J Neurol Neurosurg Psychiatry [online] 1987 Sep, 50(9):1142-7 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3668564
  3. SAVINO PETER J.. Retinal Stroke. Arch Ophthalmol [online] 1977 July [viewed 12 July 2014] Available from: doi:10.1001/archopht.1977.04450070083005
  4. SLEPYAN DH, RANKIN RM, STAHLER C JR, GIBBONS GE. Amaurosis fugax: a clinical comparison. Stroke [online] 1975 Sep-Oct, 6(5):493-6 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1179455
  5. POOLE CJ, ROSS RUSSELL RW, HARRISON P, SAVIDGE GF. Amaurosis fugax under the age of 40 years. J Neurol Neurosurg Psychiatry [online] 1987 Jan, 50(1):81-84 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1033254
  6. Current management of amaurosis fugax. The Amaurosis Fugax Study Group. Stroke [online] 1990 Feb, 21(2):201-8 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2406992
  7. SLEPYAN DH, RANKIN RM, STAHLER C JR, GIBBONS GE. Amaurosis fugax: a clinical comparison. Stroke [online] 1975 Sep-Oct, 6(5):493-6 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1179455
  8. GLUECK C. J., GOLNIK K., PING WANG . Amaurosis Fugax Caused by Heritable Thrombophilia-Hypofibrinolysis in Cases Without Carotid Atherosclerosis: Thromboprophylaxis Prevents Subsequent Transient Monocular Partial Blindness. Clinical and Applied Thrombosis/Hemostasis [online] 2007 April, 13(2):124-129 [viewed 13 July 2014] Available from: doi:10.1177/1076029606298735
  9. GAUL JJ, MARKS SJ, WEINBERGER J. Visual disturbance and carotid artery disease. 500 symptomatic patients studied by non-invasive carotid artery testing including B-mode ultrasonography. Stroke [online] 1986 May-Jun, 17(3):393-8 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3520977
  10. ADAMS HP JR, PUTMAN SF, CORBETT JJ, SIRES BP, THOMPSON HS. Amaurosis fugax: the results of arteriography in 59 patients. Stroke [online] 1983 Sep-Oct, 14(5):742-4 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6658958
  11. AMAUROSIS FUGAX. The Lancet [online] 1982 April, 319(8276):838-839 [viewed 13 July 2014] Available from: doi:10.1016/S0140-6736(82)91881-5
  12. TOREM SHLOMO, ROSSMAN MARY E., SCHNEIDER PETER A., OTIS SHIRLEY M., DILLEY RALPH B., BERNSTEIN EUGENE F.. The Natural History of Amaurosis Fugax with Minor Degrees of Internal Carotid Artery Stenosis. Annals of Vascular Surgery [online] 1990 January, 4(1):46-51 [viewed 13 July 2014] Available from: doi:10.1007/BF02042689
  13. HAYREH SS, WEINGEIST TA. Experimental occlusion of the central artery of the retina. I. Ophthalmoscopic and fluorescein fundus angiographic studies. Br J Ophthalmol [online] 1980 Dec, 64(12):896-912 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1042572
  14. FURLAN ANTHONY J.. Unilateral Visual Loss in Bright Light. Arch Neurol [online] 1979 November [viewed 13 July 2014] Available from: doi:10.1001/archneur.1979.00500470045007
  15. WILSON LA, RUSSELL RW. Amaurosis fugax and carotid artery disease: indications for angiography. Br Med J [online] 1977 Aug 13, 2(6084):435-437 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1631215

Examination

Fact Explanation
Complete eye examination The findings co-relate to the underlying conditions rather than amaurosis itself. The expected findings are retinal plaques, rubeosis iridis, neovascular glaucoma, venous stasis retinopathy, central and branch retinal artery occlusion, ischemic optic neuropathy, and asymmetric hypertensive retinopathy. Ocular signs of ischemia include occlusion of a branch retinal artery, regional retinal pallor, microinfarcts, and small hemorrhage. Distended, irregular veins and peripheral microaneurysms suggest retinal vascular insufficiency. Other than that, the ophthalmological findings are normal usually. [1], [2], [3], [4]
Complete neurological examination Look for already present neurological deficits i.e. motor weakness, sensory weakness or cranial nerve weakness. [3], [5], [6]
Complete neurological examination Look for already present neurological deficits i.e. motor weakness, sensory weakness or cranial nerve weakness. [3], [5], [6]
Complete cardiovascular examination To look for potential risk factors for or clues of cardiovascular disease. i.e. atherosclerosis, irregularly irregular pulse. [3], [7], [8], [9]
References
  1. LAWRENCE P. F., ODERICH G. S.. Ophthalmologic Findings as Predictors of Carotid Artery Disease. Vascular and Endovascular Surgery [online] 2002 November, 36(6):415-424 [viewed 13 July 2014] Available from: doi:10.1177/153857440203600602
  2. MCCULLOUGH HEATH K, REINERT CAROL G, HYNAN LINDA S, ALBISTON CHRISTY L, INMAN MARY H, BOYD PATTY I, WELBORN M.BURRESS, CLAGETT G.PATRICK, MODRALL J.GREGORY. Ocular findings as predictors of carotid artery occlusive disease: is carotid imaging justified?. Journal of Vascular Surgery [online] 2004 August, 40(2):279-286 [viewed 13 July 2014] Available from: doi:10.1016/j.jvs.2004.05.004
  3. Current management of amaurosis fugax. The Amaurosis Fugax Study Group. Stroke [online] 1990 Feb, 21(2):201-8 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2406992
  4. LEPYAN DH, RANKIN RM, STAHLER C JR, GIBBONS GE. Amaurosis fugax: a clinical comparison. Stroke [online] 1975 Sep-Oct, 6(5):493-6 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1179455
  5. LUECK C J. Neuro-ophthalmology: examination and investigation. Journal of Neurology, Neurosurgery & Psychiatry [online] 2004 December, 75(suppl_4):iv2-iv11 [viewed 14 July 2014] Available from: doi:10.1136/jnnp.2004.055293
  6. AMAUROSIS FUGAX. The Lancet [online] 1982 April, 319(8276):838-839 [viewed 18 July 2014] Available from: doi:10.1016/S0140-6736(82)91881-5
  7. KNABBEN HILDEGARD, WOLF SEBASTIAN, SOLBACH UTA, BERTRAM BERND. [Risk Factors in Patients with Amaurosis Fugax]. Klin Monatsbl Augenheilkd [online] December, 208(03):142-144 [viewed 18 July 2014] Available from: doi:10.1055/s-2008-1035187
  8. HAYREH SOHAN SINGH. Prevalent misconceptions about acute retinal vascular occlusive disorders. Progress in Retinal and Eye Research [online] 2005 July, 24(4):493-519 [viewed 18 July 2014] Available from: doi:10.1016/j.preteyeres.2004.12.001
  9. HAYREH SOHAN SINGH. Ocular vascular occlusive disorders: Natural history of visual outcome. Progress in Retinal and Eye Research [online] 2014 July, 41:1-25 [viewed 18 July 2014] Available from: doi:10.1016/j.preteyeres.2014.04.001

Differential Diagnoses

Fact Explanation
MIgraine In classical migraine, the commonest aura is of visual nature. Retinal migraine can present with the same features, monocular visual loss which happens in recurrences. In young people one can mimic the other. But unlike in amaurosis where visual loss lasts only a few minutes, it can last up to 30 minutes at a time, and in some cases of retinal migraine, can be irreversible. [1] [2] [3] [4] [5] [6] [7]
Seizure Occipital seizures can have visual auras and can mimic amaurosis fugax, and temporal epilepsies can have visual auras. careful history taking and electroencephalogram may reveal the causative factor. [8] [9] [10] [11] [12] [13] [14]
Papilloedema Visual disturbances in papilloedema is common, and can be permanent if left untreated. Papilloedema can be secondary to a space occupying lesion in the brain, i.e. brain tumor, or it can be spontaneous. It should be evaluated thoroughly with clinical examination and allowed investigations to exclude papilloedema since it can be life-threatening. [15] [16] [17] [18]
Giant cell arteritis It's a condition where visual loss can become permanent if left untreated, hence an emergency that should not be left alone. The patients can present with headache and visual loss, on examination loss of temporal arterial pulses. [19] [20] [21]
Acute glaucoma Acute glaucoma can cause acute loss of vision and if left untreated, can cause irreversible blindness. [22] [23] [24] [25]
References
  1. GROSBERG BM, SOLOMON S, FRIEDMAN DI, LIPTON RB. Retinal migraine reappraised. Cephalalgia [online] 2006 November, 26(11):1275-1286 [viewed 19 July 2014] Available from: doi:10.1111/j.1468-2982.2006.01206.x
  2. GAN KD, MOURADIAN MS, WEIS E, LEWIS JR. Transient monocular visual loss and retinal migraine. CMAJ [online] 2005 Dec 6, 173(12):1441-2 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16330630
  3. DOYLE E. Retinal migraine: caught in the act. British Journal of Ophthalmology [online] 2004 February, 88(2):301-302 [viewed 19 July 2014] Available from: doi:10.1136/bjo.2003.021808
  4. GAN KD, MOURADIAN MS, WEIS E, LEWIS JR. Transient monocular visual loss and retinal migraine CMAJ [online] 2005 Dec 6, 173(12):1441-1442 [viewed 19 July 2014] Available from: doi:10.1503/cmaj.050128
  5. O'SULLIVAN F, ROSSOR M, ELSTON JS. Amaurosis fugax in young people. Br J Ophthalmol [online] 1992 Nov, 76(11):660-662 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC504369
  6. POOLE CJ, ROSS RUSSELL RW, HARRISON P, SAVIDGE GF. Amaurosis fugax under the age of 40 years. J Neurol Neurosurg Psychiatry [online] 1987 Jan, 50(1):81-84 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1033254
  7. Nifedipine in the Treatment of Migraine Headache and Amaurosis Fugax in Patients with Systemic Lupus Erythematosus. N Engl J Med [online] 1984 October, 311(14):921-921 [viewed 19 July 2014] Available from: doi:10.1056/NEJM198410043111416
  8. PANAYIOTOPOULOS CP, SHAROQI IA, AGATHONIKOU A. Occipital seizures imitating migraine aura. J R Soc Med [online] 1997 May, 90(5):255-257 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296258
  9. SCHULZE-BONHAGE ANDREAS. [Differential diagnosis of visual aura in migraine and epilepsy]. Klin Monatsbl Augenheilkd [online] 2001 September, 218(9):595-602 [viewed 19 July 2014] Available from: doi:10.1055/s-2001-17636
  10. PANAYIOTOPOULOS CP. Visual phenomena and headache in occipital epilepsy: a review, a systematic study and differentiation from migraine. Epileptic Disord [online] 1999 Dec, 1(4):205-16 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10937155
  11. BIEN C. G., BENNINGER F. O., URBACH H., SCHRAMM J., KURTHEN M., ELGER C. E.. Localizing value of epileptic visual auras. Brain [online] 2000 February, 123(2):244-253 [viewed 19 July 2014] Available from: doi:10.1093/brain/123.2.244
  12. BINNIE CD. Progress in the treatment of epilepsy. J Neurol Neurosurg Psychiatry [online] 1990 Apr, 53(4):273-274 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1014160
  13. BRIGO FRANCESCO, TOMELLERI GIAMPAOLO, ZANONI TIZIANO, MACCARRONE GIUSEPPE, BOVI PAOLO, MORETTO GIUSEPPE. Oculo-pyramidal crossed syndrome heralded by seizure: a case report. Neurol Sci [online] December, 32(5):967-968 [viewed 19 July 2014] Available from: doi:10.1007/s10072-011-0585-5
  14. MANFORD M.. Assessment and Investigation of Possible Epileptic Seizures. J Neurol Neurosurg Psychiatry [online] 2001 June, 70(90002):3ii-8 [viewed 19 July 2014] Available from: doi:10.1136/jnnp.70.suppl_2.ii3
  15. SCHIRMER CM, HEDGES TR 3RD. Mechanisms of visual loss in papilledema. Neurosurg Focus [online] 2007, 23(5):E5 [viewed 19 July 2014] Available from: doi:10.3171/FOC-07/11/E5
  16. RIBILA JONATHAN T, RONAN SHAWN M, TROBE JONATHAN D. Multiple Intracranial Meningiomas Causing Papilledema and Visual Loss in a Patient With Nevoid Basal Cell Carcinoma Syndrome. Journal of Neuro-Ophthalmology [online] 2008 March, 28(1):41-46 [viewed 19 July 2014] Available from: doi:10.1097/WNO.0b013e318167540e
  17. ONG HON SHING, FRASER CLARE, DAVAGNANAM INDRAN, PLANT GORDON T.. Acute visual loss in papilloedema: the diagnostic pitfalls. Int Ophthalmol [online] December, 34(3):607-612 [viewed 19 July 2014] Available from: doi:10.1007/s10792-013-9811-x
  18. WALL M, WHITE WN 2ND. Asymmetric papilledema in idiopathic intracranial hypertension: prospective interocular comparison of sensory visual function. Invest Ophthalmol Vis Sci [online] 1998 Jan, 39(1):134-42 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/943055
  19. CALVO-ROMERO J M. Giant cell arteritis. Postgraduate Medical Journal [online] 2003 September, 79(935):511-515 [viewed 19 July 2014] Available from: doi:10.1136/pmj.79.935.511
  20. SCHEURER RYAN A., HARRISON ANDREW R., LEE MICHAEL S.. Treatment of Vision Loss in Giant Cell Arteritis. Curr Treat Options Neurol [online] December, 14(1):84-92 [viewed 19 July 2014] Available from: doi:10.1007/s11940-011-0152-7
  21. DANESHMEYER H, SAVINO P, GAMBLE G. Poor Prognosis of Visual Outcome after Visual Loss from Giant Cell Arteritis. Ophthalmology [online] 2005 June, 112(6):1098-1103 [viewed 19 July 2014] Available from: doi:10.1016/j.ophtha.2005.01.036
  22. SHARMA S, CHEUNG J. Ophthaproblem. Acute angle-closure glaucoma. Can Fam Physician [online] 2000 Feb:303-312 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1987701
  23. LACHKAR YVES, BOUASSIDA WALID. Drug-induced acute angle closure glaucoma. Current Opinion in Ophthalmology [online] 2007 March, 18(2):129-133 [viewed 19 July 2014] Available from: doi:10.1097/ICU.0b013e32808738d5
  24. DAVID R, TESSLER Z, YASSUR Y. Long-term outcome of primary acute angle-closure glaucoma. Br J Ophthalmol [online] 1985 Apr, 69(4):261-262 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1040578
  25. CHOONG YEE FONG, IRFAN SAMEERA, MENAGE MITCHEL J. Acute angle closure glaucoma: An evaluation of a protocol for acute treatment. Eye [online] 1999 September, 13(5):613-616 [viewed 19 July 2014] Available from: doi:10.1038/eye.1999.168

Investigations - for Diagnosis

Fact Explanation
Color Doppler studies of retinal vasculature To define the site of occlusion. [1], [2], [3]
Angiography of carotid arteries Since carotid artery diseases are a major cause in amaurosis fugax, it's important to rule out any pathologies in the carotid arteries. [4], [5], [6], [7], [8]
Erythrocyte sedimentation rate To look for an inflammatory cause for occlusion. i.e. giant cell arteritis [9], [10]
Oculoplethysmography Angiography has associated morbidity and mortality, so this is used to assess vasculature where angiography is undesired. [11], [12], [13]
References
  1. HAYREH SOHAN S., ZIMMERMAN M. BRIDGET. Amaurosis fugax in ocular vascular occlusive disorders: prevalence and pathogeneses. Retina [online] 2014 January, 34(1):115-122 [viewed 19 July 2014] Available from: doi:10.1097/IAE.0b013e31829234b5
  2. Current management of amaurosis fugax. The Amaurosis Fugax Study Group. Stroke [online] 1990 Feb, 21(2):201-8 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2406992
  3. SERGOTT RC, FLAHARTY PM, LIEB WE JR, HO AC, KAY MD, MITTRA RA, SAVINO PJ, BOSLEY TM. Color Doppler imaging identifies four syndromes of the retrobulbar circulation in patients with amaurosis fugax and central retinal artery occlusions. Trans Am Ophthalmol Soc [online] 1992:383-98; discussion 398-401 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1494830
  4. WILSON LA, RUSSELL RW. Amaurosis fugax and carotid artery disease: indications for angiography. Br Med J [online] 1977 Aug 13, 2(6084):435-437 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1631215
  5. WEINBERGER J., BENDER A. N., YANG W. C.. Amaurosis fugax associated with ophthalmic artery stenosis: clinical simulation of carotid artery disease. Stroke [online] 1980 May, 11(3):290-293 [viewed 19 July 2014] Available from: doi:10.1161/​01.STR.11.3.290
  6. WALSH JOHN, MARKOWITZ IRA, KERSTEIN MORRIS D.. Carotid endarterectomy for amaurosis fugax without angiography. The American Journal of Surgery [online] 1986 August, 152(2):172-174 [viewed 19 July 2014] Available from: doi:10.1016/0002-9610(86)90236-9
  7. DUGAN J D, GREEN W R. Ophthalmologic manifestations of carotid occlusive disease. Eye [online] 1991 March, 5(2):226-238 [viewed 19 July 2014] Available from: doi:10.1038/eye.1991.38
  8. BURNBAUM M. D., SELHORST J. B., HARBISON J. W., BRUSH J. J.. Amaurosis Fugax From Disease of the External Carotid Artery. Archives of Neurology [online] 1977 September, 34(9):532-535 [viewed 19 July 2014] Available from: doi:10.1001/archneur.1977.00500210034004
  9. LIOZON E., LY K.-H., ROBERT P.-Y.. Manifestations ophtalmologiques de la maladie de Horton. La Revue de Médecine Interne [online] 2013 July, 34(7):421-430 [viewed 19 July 2014] Available from: doi:10.1016/j.revmed.2013.02.030
  10. CACKETT P, WEIR C. Wegener’s granulomatosis presenting with amaurosis fugax. Eye [online] December, 16(5):676-676 [viewed 19 July 2014] Available from: doi:10.1038/sj.eye.6700107
  11. WALSH JOHN, MARKOWITZ IRA, KERSTEIN MORRIS D.. Carotid endarterectomy for amaurosis fugax without angiography. The American Journal of Surgery [online] 1986 August, 152(2):172-174 [viewed 19 July 2014] Available from: doi:10.1016/0002-9610(86)90236-9
  12. WEINBERGER JESSE. Clinical applications of noninvasive carotid artery testing. Journal of the American College of Cardiology [online] 1985 January, 5(1):137-148 [viewed 19 July 2014] Available from: doi:10.1016/S0735-1097(85)80097-8
  13. CHUKWUDELUNZU FELIX E., RUBINO FRANK A.. 61-Year-Old Man With Recurrent Spells. Mayo Clinic Proceedings [online] 1999 December, 74(12):1261-1264 [viewed 19 July 2014] Available from: doi:10.4065/74.12.1261

Investigations - Fitness for Management

Fact Explanation
Complete blood count To exclude presence of an infection or anemia prior to surgery. [1] [2] [3] [4]
Liver function tests i.e. Serum transaminases, bilirubin, gamma-GT, albumin and total protein. To exclude liver disease prior to surgery. [5] [6] [7]
Renal function tests i.e. serum electrolytes, urine full report, serum creatinine. To exclude renal disorders prior to surgery. [7]
Chest X-ray To exclude respiratory illness prior to surgery. [8] [9]
Fasting blood sugar To look for diabetes as a risk factor for embolism and to exclude it prior to surgery. [10]
Lipid profile To look for dyslipidemia as a risk factor for embolism and to exclude lipid disorder prior to surgery. [11]
12 lead electrocardiogram To exclude presence of atrial fibrillations a causative factor for embolism. [12] [13]
Echocardiogram To exclude the presence of luminal thrombus. [14] [15]
References
  1. BILLER J., FEINBERG W. M., CASTALDO J. E., WHITTEMORE A. D., HARBAUGH R. E., DEMPSEY R. J., CAPLAN L. R., KRESOWIK T. F., MATCHAR D. B., TOOLE J. F., EASTON J. D., ADAMS H. P., BRASS L. M., HOBSON R. W., BROTT T. G., STERNAU L.. Guidelines for Carotid Endarterectomy : A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Circulation [online] 1998 February, 97(5):501-509 [viewed 19 July 2014] Available from: doi:10.1161/​01.CIR.97.5.501
  2. MCCRORY DC, GOLDSTEIN LB, SAMSA GP, ODDONE EZ, LANDSMAN PB, MOORE WS, MATCHAR DB. Predicting complications of carotid endarterectomy. Stroke [online] 1993 Sep, 24(9):1285-91 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8362419
  3. APIRO MARTIN F.. Diagnostic Decision: The Complete Blood Count and Leukocyte Differential Count: An Approach to Their Rational Application. Ann Intern Med [online] 1987 January [viewed 08 June 2014] Available from: doi:10.7326/0003-4819-106-1-65
  4. BLUMENREICH MS. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition [web]; Chapter 153, The White Blood Cell and Differential Count. [viewed 08 June 2014] Available at http://www.ncbi.nlm.nih.gov/books/NBK261/
  5. AHMAD NZ. Routine Testing of Liver Function Before and After Elective Laparoscopic Cholecystectomy: Is It Necessary? JSLS [online] 2011, 15(1):65-69 [viewed 19 July 2014] Available from: doi:10.4293/108680811X13022985131291
  6. SHAHBAZI S, PANAH A, SAHMEDDINI MA. Evaluation of factors influencing liver function test in on-pump coronary artery bypass graft surgery. Iran J Med Sci [online] 2013 Dec, 38(4):308-13 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24293784
  7. MATHEW A, ELIASZIW M, DEVEREAUX PJ, MERINO JG, BARNETT HJ, GARG AX, FOR THE NORTH AMERICAN SYMPTOMATIC CAROTID ENDARTERECTOMY TRIAL (NASCET) COLLABORATORS. Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis J Am Soc Nephrol [online] 2010 Jan, 21(1):145-152 [viewed 19 July 2014] Available from: doi:10.1681/ASN.2009030287
  8. DA ROSA MP, SCHWENDLER R, LOPES R, PORTAL VL. Carotid Artery Stenosis Associated with Increased Mortality in Patients who Underwent Coronary Artery Bypass Grafting: A Single Center Experience Open Cardiovasc Med J [online] :76-81 [viewed 19 July 2014] Available from: doi:10.2174/1874192401307010076
  9. GUILBERT MARIE-CHRISTINE, ELKOURI STEPHANE, BRACCO DAVID, CORRIVEAU MARC M., BEAUDOIN NATHALIE, DUBOIS MARC JACQUES, BRUNEAU LUC, BLAIR JEAN-FRANçOIS. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. Journal of Vascular Surgery [online] 2008 October, 48(4):918-925 [viewed 19 July 2014] Available from: doi:10.1016/j.jvs.2008.04.046
  10. JOOB B, WIWANITKIT V. Fasting blood sugar for diagnosis of diabetes mellitus in patients with tuberculosis Lung India [online] 2012, 29(1):90 [viewed 19 July 2014] Available from: doi:10.4103/0970-2113.92379
  11. TOLONEN H, FERRARIO M, KUULASMAA K, WHO MONICA PROJECT. Standardization of total cholesterol measurement in population surveys--pre-analytic sources of variation and their effect on the prevalence of hypercholesterolaemia. Eur J Cardiovasc Prev Rehabil [online] 2005 Jun, 12(3):257-67 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15942425
  12. KLEMM HANNO U., VENTURA RODOLFO, ROSTOCK THOMAS, BRANDSTRUP BENEDIKT, RISIUS TIM, MEINERTZ THOMAS, WILLEMS STEPHAN. Correlation of Symptoms to ECG Diagnosis Following Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol [online] 2006 February, 17(2):146-150 [viewed 19 July 2014] Available from: doi:10.1111/j.1540-8167.2005.00288.x
  13. PLATONOV PG. Atrial conduction and atrial fibrillation: what can we learn from surface ECG? Cardiol J [online] 2008, 15(5):402-7 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18810714
  14. KAWABORI MASAHITO, YOSHIMOTO TETSUYUKI, ITO MASAKI, FUJIMOTO SHIN, MIKAMI TAISEI, MURAKI MUTSUKO, KANEKO SADAO, NAKAYAMA NAOKI, KURODA SATOSHI, HOUKIN KIYOHIRO. Spontaneous Echo Contrast and Thrombus Formation at the Carotid Bifurcation After Carotid Endarterectomy. Neurol. Med. Chir.(Tokyo) [online] 2012 December, 52(12):885-891 [viewed 19 July 2014] Available from: doi:10.2176/nmc.52.885
  15. CRIADO ENRIQUE, WALL PHILLIP, LUCAS PAUL, GASPARIS ANTONIOS, PROFFIT TRENT, RICOTTA JOHN. Transesophageal echo-guided endovascular exclusion of thoracic aortic mobile thrombi. Journal of Vascular Surgery [online] 2004 January, 39(1):238-242 [viewed 19 July 2014] Available from: doi:10.1016/j.jvs.2003.07.017

Investigations - Followup

Fact Explanation
Follow up for neurological syndromes i.e. stroke. Since the pathologies behind amaurosis fugax and vascular accidents are somewhat similar, it's necessary to follow up previous neurological incidents or screen out future risks (ref. investigations for fitness) i.e. lipid profiles, fasting blood sugar, serum electrolytes. [1], [2], [3], [4], [5]
References
  1. SLEPYAN DH, RANKIN RM, STAHLER C JR, GIBBONS GE. Amaurosis fugax: a clinical comparison. Stroke [online] 1975 Sep-Oct, 6(5):493-6 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1179455
  2. Current management of amaurosis fugax. The Amaurosis Fugax Study Group. Stroke [online] 1990 Feb, 21(2):201-8 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2406992
  3. POOLE CJ, ROSS RUSSELL RW. Mortality and stroke after amaurosis fugax. J Neurol Neurosurg Psychiatry [online] 1985 Sep, 48(9):902-905 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1028491
  4. HOWARD RS, RUSSELL RW. Prognosis of patients with retinal embolism. J Neurol Neurosurg Psychiatry [online] 1987 Sep, 50(9):1142-7 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3668564
  5. AVINO PETER J.. Retinal Stroke. Arch Ophthalmol [online] 1977 July [viewed 12 July 2014] Available from: doi:10.1001/archopht.1977.04450070083005

Investigations - Screening/Staging

Fact Explanation
Screening for the risk of stroke The investigations that are used to screen for stroke should be carried out. i.e. lipid profile, fasting blood glucose, serum electrolytes. [1], [2], [3], [4], [5]
References
  1. SLEPYAN DH, RANKIN RM, STAHLER C JR, GIBBONS GE. Amaurosis fugax: a clinical comparison. Stroke [online] 1975 Sep-Oct, 6(5):493-6 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1179455
  2. Current management of amaurosis fugax. The Amaurosis Fugax Study Group. Stroke [online] 1990 Feb, 21(2):201-8 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2406992
  3. POOLE CJ, ROSS RUSSELL RW. Mortality and stroke after amaurosis fugax. J Neurol Neurosurg Psychiatry [online] 1985 Sep, 48(9):902-905 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1028491
  4. HOWARD RS, RUSSELL RW. Prognosis of patients with retinal embolism. J Neurol Neurosurg Psychiatry [online] 1987 Sep, 50(9):1142-7 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3668564
  5. AVINO PETER J.. Retinal Stroke. Arch Ophthalmol [online] 1977 July [viewed 12 July 2014] Available from: doi:10.1001/archopht.1977.04450070083005

Management - General Measures

Fact Explanation
Remove risk factors for stroke Remove or reduce risk factors for cardiovascular and cerebrovascular diseases. [1] [2] [3] [4] [5]
Patient education Education about the nature of the condition, risk for future vascular incidents, and the importance of removing the modifiable risk factors can improve the survival. [6] [7] [8] [9]
References
  1. MEAD G. E., LEWIS S. C., WARDLAW J. M., DENNIS M. S.. Comparison of Risk Factors in Patients With Transient and Prolonged Eye and Brain Ischemic Syndromes. Stroke [online] 2002 October, 33(10):2383-2390 [viewed 19 July 2014] Available from: doi:10.1161/​01.STR.0000029827.93497.97
  2. BERNSTEIN EUGENE F., KAPLAN JEFFREY H., SCALA TERESE E., KOZIOL JAMES A., DILLEY RALPH B.. CHAT analysis of the influence of specific risk factors on late results after carotid endarterectomy. Journal of Vascular Surgery [online] 1992 October, 16(4):575-587 [viewed 19 July 2014] Available from: doi:10.1016/0741-5214(92)90165-5
  3. SLEPYAN DH, RANKIN RM, STAHLER C JR, GIBBONS GE. Amaurosis fugax: a clinical comparison. Stroke [online] 1975 Sep-Oct, 6(5):493-6 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1179455
  4. Current management of amaurosis fugax. The Amaurosis Fugax Study Group. Stroke [online] 1990 Feb, 21(2):201-8 [viewed 13 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2406992
  5. BILLER J., FEINBERG W. M., CASTALDO J. E., WHITTEMORE A. D., HARBAUGH R. E., DEMPSEY R. J., CAPLAN L. R., KRESOWIK T. F., MATCHAR D. B., TOOLE J. F., EASTON J. D., ADAMS H. P., BRASS L. M., HOBSON R. W., BROTT T. G., STERNAU L.. Guidelines for Carotid Endarterectomy : A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Circulation [online] 1998 February, 97(5):501-509 [viewed 19 July 2014] Available from: doi:10.1161/​01.CIR.97.5.501
  6. BERRA KATHY. Challenges of Changing Lifestyle to Reduce Risk for Cardiovascular Disease. The Journal of Cardiovascular Nursing [online] 2010 December, 25(3):223-227 [viewed 19 July 2014] Available from: doi:10.1097/JCN.0b013e3181cec7e4
  7. TOUGER-DECKER R. Diet, cardiovascular disease and oral health: promoting health and reducing risk. J Am Dent Assoc [online] 2010 Feb, 141(2):167-70 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/20123875
  8. SOURETI ANASTASIA, HURLING ROBERT, MURRAY PETER, VAN MECHELEN WILLEM, COBAIN MARK. Evaluation of a cardiovascular disease risk assessment tool for the promotion of healthier lifestyles. European Journal of Cardiovascular Prevention & Rehabilitation [online] 2010 October, 17(5):519-523 [viewed 19 July 2014] Available from: doi:10.1097/HJR.0b013e328337ccd3
  9. WIESEMANN ARMIN, LUDT SABINE, SZECSENYI JOACHIM, SCHEUERMANN WOLFGANG, SCHEIDT REGINALD. Cardiovascular risk factors and motivation for a healthy life-style in a German community—results of the GP-based Oestringen study. Patient Education and Counseling [online] 2004 October, 55(1):40-47 [viewed 19 July 2014] Available from: doi:10.1016/j.pec.2003.07.002

Management - Specific Treatments

Fact Explanation
Aspirin Adding low dose daily aspirin for stroke prevention has been proved to be useful. [1] [2] [3] [4]
Carotid endarterectomy Where embolization via carotid arteries have been proved the source of occlusion and in symptomatic patients. [5] [6] [7] [8] [9]
Managing the co-morbidities. Since amaurosis is linked too closely with current or future vascular pathologies, it's important to manage them together to get the best outcome. [10] [11] [12] [13] [14] [15]
References
  1. SLEPYAN DH, RANKIN RM, STAHLER C JR, GIBBONS GE. Amaurosis fugax: a clinical comparison. Stroke [online] 1975 Sep-Oct, 6(5):493-6 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1179455
  2. Current management of amaurosis fugax. The Amaurosis Fugax Study Group. Stroke [online] 1990 February, 21(2):201-208 [viewed 19 July 2014] Available from: doi:10.1161/01.STR.21.2.201
  3. HEPLER RS. Amaurosis Fugax and Its Significance West J Med [online] 1975 Mar, 122(3):239-240 [viewed 19 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1129685
  4. AMAUROSIS FUGAX. The Lancet [online] 1982 April, 319(8276):838-839 [viewed 19 July 2014] Available from: doi:10.1016/S0140-6736(82)91881-5
  5. BERNSTEIN EUGENE F., DILLEY RALPH B.. Late results after carotid endarterectomy for amaurosis fugax. Journal of Vascular Surgery [online] 1987 October, 6(4):333-340 [viewed 19 July 2014] Available from: doi:10.1016/0741-5214(87)90003-6
  6. WALSH JOHN, MARKOWITZ IRA, KERSTEIN MORRIS D.. Carotid endarterectomy for amaurosis fugax without angiography. The American Journal of Surgery [online] 1986 August, 152(2):172-174 [viewed 19 July 2014] Available from: doi:10.1016/0002-9610(86)90236-9
  7. KULKARNI S, GOHEL M, BULBULIA R, WHYMAN M, POSKITT K. The Importance of Early Carotid Endarterectomy in Symptomatic Patients Ann R Coll Surg Engl [online] 2009 Apr, 91(3):210-213 [viewed 19 July 2014] Available from: doi:10.1308/003588409X359312
  8. STERPETTI ANTONIO V., SCHULTZ RICHARD D., FELDHAUS RICHARD J.. External carotid endarterectomy: Indications, technique, and late results. Journal of Vascular Surgery [online] 1988 January, 7(1):31-39 [viewed 19 July 2014] Available from: doi:10.1016/0741-5214(88)90376-X
  9. ROSENTHAL DAVID, HUNGERPILLER JOHN C., CRISPIN MARK E., CLARK MICHAEL D., LAMIS PANO A., PALLOS L. LASZLO. Amaurosis Fugax: Is it Innocuous?. Annals of Vascular Surgery [online] 1992 May, 6(3):281-288 [viewed 19 July 2014] Available from: doi:10.1007/BF02000275
  10. POOLE CJ, ROSS RUSSELL RW. Mortality and stroke after amaurosis fugax. J Neurol Neurosurg Psychiatry [online] 1985 Sep, 48(9):902-905 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1028491
  11. HOWARD RS, RUSSELL RW. Prognosis of patients with retinal embolism. J Neurol Neurosurg Psychiatry [online] 1987 Sep, 50(9):1142-7 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/3668564
  12. SAVINO PETER J.. Retinal Stroke. Arch Ophthalmol [online] 1977 July [viewed 12 July 2014] Available from: doi:10.1001/archopht.1977.04450070083005
  13. SLEPYAN DH, RANKIN RM, STAHLER C JR, GIBBONS GE. Amaurosis fugax: a clinical comparison. Stroke [online] 1975 Sep-Oct, 6(5):493-6 [viewed 12 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1179455
  14. HAYREH SOHAN S., ZIMMERMAN M. BRIDGET. Amaurosis Fugax In Ocular Vascular Occlusive Disorders. Retina [online] 2014 January, 34(1):115-122 [viewed 12 July 2014] Available from: doi:10.1097/IAE.0b013e31829234b5
  15. BILLER J., FEINBERG W. M., CASTALDO J. E., WHITTEMORE A. D., HARBAUGH R. E., DEMPSEY R. J., CAPLAN L. R., KRESOWIK T. F., MATCHAR D. B., TOOLE J. F., EASTON J. D., ADAMS H. P., BRASS L. M., HOBSON R. W., BROTT T. G., STERNAU L.. Guidelines for Carotid Endarterectomy : A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Circulation [online] 1998 February, 97(5):501-509 [viewed 19 July 2014] Available from: doi:10.1161/​01.CIR.97.5.501