Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec;28(12):4098-4108.
doi: 10.1111/ene.15074. Epub 2021 Sep 5.

Vascular origin in acute transient visual disturbance: A prospective study

Michael Obadia  1 , Cedric Lamirel  2 , Elena Meseguer  3 , Pierre Seners  1 , Kevin Zuber  4 , Michel Rosenheim  4 , Amelie Yavchitz  4 , Samuel Bidot  2 , Rabih Hage  2 , Candice Sabben  1 , Julien Savatovsky  5 , Philippa C Lavallée  3 , Olivier Gout  1 , Catherine Vignal  2 , Pierre Amarenco  3
Affiliations

Vascular origin in acute transient visual disturbance: A prospective study

Michael Obadia et al. Eur J Neurol. 2021 Dec.

Abstract

Background and purpose: This study was undertaken to validate a clinical score of vascular origin in patients with acute transient visual disturbances (TVDs) without diplopia.

Methods: We conducted a prospective study in an ophthalmology emergency department and a transient ischemic attack (TIA) clinic. Patients underwent clinical evaluation including a tailored questionnaire, brain, vascular, and ophthalmologic investigations, and 3-month follow-up. TVDs were classified according to vascular or nonvascular origin by three independent experts based on all clinical, cerebrovascular, and ophthalmologic investigations, but blind to the questionnaire results. A clinical score was derived based on clinical variables independently associated with a vascular origin, and was externally validated in an independent cohort.

Results: An ischemic origin of TVD was found in 45% (67/149) of patients in the derivation cohort. Age and six questions were independently associated with an ischemic origin. A nine-point score (≥70 years old = 2; monocular visual loss = 2; black or white vision = 1; single episode = 1; lack of headache = 2; diffuse, constricted, altitudinal, or lateralized visual loss pattern on drawings = 1) showed good discriminative power in identifying ischemic origin (c-statistic = 0.82) and was replicated in the validation cohort (n = 130, 25% of ischemic origin, c-statistic = 0.75). With a score ≥ 4, sensitivity was 85% (95% confidence interval = 68-95) and specificity was 52% (95% confidence interval = 41-62). In both cohorts, ophthalmologic evaluation found a vascular cause in 4% and was noncontributive in 85%. After 3 months, no patients had a stroke, TIA, or retinal infarct.

Conclusions: Our score may assist in predicting a vascular origin of TVD. Ophthalmologic evaluation, when not readily available, should not delay the neurovascular evaluation.

Keywords: amaurosis fugax; clinical neurology; prospective cohort study; transient ischemic attack; transient monocular visual loss; transient visual disturbance; transient visual loss.

PubMed Disclaimer

References

REFERENCES

    1. Biousse V, Trobe JD. Transient monocular visual loss. Am J Ophthalmol. 2005;140:717-721.
    1. Lavallée PC, Cabrejo L, Labreuche J, et al. Spectrum of transient visual symptoms in a transient ischemic attack cohort. Stroke. 2013;44:3312-3317.
    1. Arsava EM, Kim G-M, Oliveira-Filho J, et al. Prediction of early recurrence after acute ischemic stroke. JAMA Neurol. 2016;73:396-401.
    1. McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379:1509-1518.
    1. Castle J, Mlynash M, Lee K, et al. Agreement regarding diagnosis of transient ischemic attack fairly low among stroke-trained neurologists. Stroke. 2010;41:1367-1370.

LinkOut - more resources