The extracranial carotid systems of 105 patients with retinal ischemia were examined using B-mode ultrasonography with integrated pulsed Doppler. Sixty-four patients had amaurosis fugax (AF), 17 central retinal artery occlusions (CRAO), and 21 branch retinal artery occlusions (BRAO). The prevalence of carotid stenosis (greater than or equal to 60%) ipsilateral to the symptomatic eye was low (16%). Eighty-six percent of AF patients had either no plaque causing less than a 60% stenosis. A significant proportion of subjects with normal duplex scans had alternative explanations for their retinal ischemia (eg, migraine, cardiac embolus). Patients with Hollenhorst plaques were more likely to have stenotic or ulcerated plaque (p = 0.04). The degree of carotid stenosis correlated significantly with the number of vascular risk factors identified in individual patients (p = 0.02). The presence of risk factors was more common in CRAO and BRAO patients compared with the AF group. Combined ultrasound-Doppler investigations of the carotid bifurcation are valuable noninvasive tools for the screening of patients with retinal ischemia.
This case is an example of an uncommon malady in which our knowledge of its etiology may be furthered by fully recording each case as it occurs.The condition is characterized by marked cardiac enlargement and often cardiac failure in an infant or young child, but without evidence of the usual causes of such enlargement.
Case HistoryA boy, aged fourteen months, was brought to University College Hospital late one night because the parents were alarmed by his rapid breathing, unusual bouts of screaming, and refusal to eat. Two days previously he had returned by car from a seaside holiday, and after the journey appeared unwell and refused to eat. The following day he was still fretful and rather feverish. He had diarrhoea, and vomited on one occasion. On the day of admission he became more miserable, and his breathing was laboured. He was thirsty, but refused food and had bouts of screaming.His birth had been normal, and the child had been apparently healthy with no previous illnesses until an attack of measles six weeks before admission. He was the first child of a healthy mother who had been well throughout pregnancy, and had not suffered any earlier miscarriages. The father had had ulcerative colitis for many years. There was no consanguinity between the parents, and no history of heart trouble or sudden deaths in childhood on either side of the family.On admission the child was noticed to be pale and perspiring but without obvious cyanosis or venous engorgement. The temperature was 100°F. and the respiration rate 90 per minute. There was slight injection of the left tympanic membrane but the rest of the upper respiratory tract was normal. In the chest the percussion note was nornmal, the breath sounds were loud at both lung bases, and no adventitious sounds were heard. The beart sounds were normal and the rate 112 per minute. The heart size was not estimated. In the abdomen the spleen was not palpable and there was no ascites.The liver was palpable three fingers below the right costal margin. Other systems were normal. An x-ray examination of the chest showed well marked cardiac enlargement ( fig. 1)
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