Alternating Amaurosis Fugax in Trousseau Syndrome: A Case Report

Kunitake, Katsuhiko; Inagaki, R.; Furukawa, Soma; Kitagawa, Satoshi; Oguchi, Hidenori; Ito, Yasuhiro

doi:10.1016/j.jstrokecerebrovasdis.2019.04.018

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…Systemic diseases are also often associated with amaurosis fugax. These include heritable thrombophilia [6][7], Trousseau syndrome [8] and antiphospholipid syndrome [9]. In our patient, systemic risk factors for thrombotic events in young patients including systemic lupus erythematosus, young hypertension, diabetes mellitus, antiphospholipid syndrome, thrombophilia, familial hyperlipidemia and Moyamoya disease had been ruled out.…”

Section: Discussionmentioning

confidence: 79%

Lights Off, Lights On: Amaurosis Fugax in Polycythemia

Tan¹,

Samsudin²,

Thavaratnam³

et al. 2022

Cureus

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There are many causes of amaurosis fugax, including polycythemia. Polycythemia is associated with elevated hematocrit levels and hyperviscosity, which can lead to ocular manifestations. We report a polycythemia patient with amaurosis fugax, who had resolution of ocular symptoms following venesection. A 29-year-old gentleman presented with a six-month history of episodic bilateral transient loss of vision (amaurosis fugax), followed by slow recovery back to normal after 15-20 minutes. The symptoms worsened with fatigue. He also had an unsteady gait for the preceding one year. Ocular examination was unremarkable. His visual acuity was 20/20 OU. Neurological examination revealed gait ataxia and dysdiadochokinesia. Computed tomography (CT) angiogram showed an old cerebellar infarct. Blood investigations showed persistent elevated hemoglobin and hematocrit with positive JAK-2 V617F mutation. Infective and connective tissue workups were all negative. A diagnosis of polycythemia was made by the haematology team. In addition to oral aspirin given by the neurology team, he underwent venesection with improvement in ocular symptoms following each episode of venesection. The frequency of amaurosis fugax reduced from 2-3 episodes a week to once a month, then resolved completely after five venesections. Systemically, his cerebellar symptoms also resolved and there were no neurological deficits. Polycythemia is a rare disease that can cause amaurosis fugax and thrombotic events in young patients. Better knowledge and accurate diagnosis are important, as early treatment may improve the symptoms and long-term morbidity.

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Section: Discussionmentioning

confidence: 79%

Lights Off, Lights On: Amaurosis Fugax in Polycythemia

Tan¹,

Samsudin²,

Thavaratnam³

et al. 2022

Cureus

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“…The characteristics of individuals participating were very similar among different study groups ( Table 1 ). All participants in study groups were well-matched without significant differences in gender, age, coronary artery disease (CAD) defined as coronary arteries with stenosis ≥ 50% in a major epicardial coronary arteries [ 32 ], hypertension defined as blood pressure higher than 130/80 mmHg [ 33 ], diabetes mellitus defined as fasting plasma glucose ≥ 126 mg/dL (7 mmol/L) [ 34 ], history of stroke defined as intracranial ischemia and hemorrhage [ 35 ], current smoking defined as >20 pack-years and >20 joint-years, respectively [ 36 ], current drinking defined as any alcoholic drinking and alcoholic binge drinking as consuming five or more drinks on one or more occasion, both in the past two months [ 37 ], regular exercise defined as any kind of favorite recreational or sport and physical activity other than simply walking more than three days a week for at least twenty minutes [ 38 ], myocardial infarction defined as sudden ischemic necrosis of myocardial tissue [ 39 ], dizziness defined as persistent subjective unsteadiness [ 40 ], memory impairment defined as delayed word recall test score < 4 and poor cognitive function by mini-mental state examination score < 25 [ 41 ], amaurosis fugax defined as transient monocular vision loss secondary to the retinal ischemia [ 42 ], cognitive impairment defined as impairment of ≥2 cognitive tests [ 43 ], and angina pectoris defined as pain, pressure, or discomfort in the chest [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

Oxidative Stress and Inflammation Are Associated with Coexistent Severe Multivessel Coronary Artery Stenosis and Right Carotid Artery Severe Stenosis in Elderly Patients

Guo

et al. 2021

Oxidative Medicine and Cellular Longevity

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Oxidative stress and inflammatory response are the main pathogenic pathways in atherosclerosis stenosis. This study is aimed at evaluating the roles of oxidative stress and inflammatory response in coexistent right carotid artery severe stenosis and severe multivessel coronary artery stenosis in elderly patients. Circulating levels of total oxidant status (TOS), lipid hydroperoxide (LHP), 8-isoprostane (8-IP), malondialdehyde (MDA), monocyte chemotactic protein-4 (MCP-4), amyloid A (AA), high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α) were measured by standardised laboratory test methods. Markers of oxidative stress and inflammatory response: levels of TOS, LHP, 8-IP, MDA, MCP-4, AA, hs-CRP, and TNF-α, were increased ( P < 0.001 ) in elderly patient. These results suggested that oxidative stress and inflammatory response may be involved in carotid artery severe stenosis and severe multivessel coronary artery stenosis and measuring oxidative stress and inflammation biomarkers may also be a promising step in the development of an effective method for monitoring the severity of right carotid artery stenosis and multivessel coronary artery stenosis in elderly patients.

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“…The patient had high signal findings in the cerebral cortex and basal ganglia on MRI, elevated D-dimer, and increased CA19-9 and CA125 levels in the blood test. Kunitake et al [ 7 ] reported a 64-year-old woman diagnosed with Trousseau syndrome due to ovarian cancer after experiencing amaurosis fugax in both eyes alternately. Both cases had multiple cerebral infarctions following the onset of unilateral retinal artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…Both cases had multiple cerebral infarctions following the onset of unilateral retinal artery occlusion. The patient had high signal findings in the cerebral cortex and basal ganglia on MRI, elevated D-dimer, and increased CA19-9 and CA125 levels in the blood test [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Trousseau’s Syndrome With Severe Visual Loss As the Initial Symptom

Okubo,

Obata,

Azuma

et al. 2024

Cureus

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There are limited reports on patients with Trousseau syndrome, a condition characterized by hypercoagulability associated with malignant tumors, initially manifesting with reduced visual function. We present a case of a patient who experienced bilateral vision loss and was subsequently diagnosed with Trousseau's syndrome following examination and investigations. A 70-year-old man, undergoing chemotherapy for advanced pancreatic cancer, reported decreased visual acuity in both eyes. A dilated fundus examination revealed retinal pigment epithelial atrophy in the posterior pole and cotton-wool spots. Optical coherence tomography exhibited partial disruption of the ellipsoid zone in the parafoveal region, and full-field electroretinogram results were subnormal, although the macular retinal structure was preserved. Brain magnetic resonance imaging (MRI) detected occipital lobe infarction. Elevated coagulability markers, including D-dimer (5.5μg/mL), led to the diagnosis of Trousseau's syndrome. In cases where patients with malignant tumors present with profound visual loss, considering the possibility of Trousseau's syndrome and conducting assessments of brain function and coagulability is crucial for accurate diagnosis and appropriate management.

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Alternating Amaurosis Fugax in Trousseau Syndrome: A Case Report

Cited by 5 publications

References 7 publications

Lights Off, Lights On: Amaurosis Fugax in Polycythemia

Lights Off, Lights On: Amaurosis Fugax in Polycythemia

Oxidative Stress and Inflammation Are Associated with Coexistent Severe Multivessel Coronary Artery Stenosis and Right Carotid Artery Severe Stenosis in Elderly Patients

Trousseau’s Syndrome With Severe Visual Loss As the Initial Symptom

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