so today we're gonna be talking about amaurosis fugax amaurosis fugax means fleeting blindness it's kind of a weird word because it's a combination of both Latin and Greek fleeting blindness and so I prefer the term transient monocular vision loss when it's amaurosis reais and what I you could say transient bilateral vision loss and if it's to ice and so when we're dealing with transient monocular vision loss or transient bilateral vision loss we're really talking about two circulations that could be involved if the amaurosis fugax is due to a transient ischemic attack at eia and so when we have amaurosis fugax a transient vision loss we'd like to make sure it's not a TI a as the TI a could become a stroke oil easily and so this is actually an emergency and we should work it up as a stroke in evolution however transient monocular vision loss can occur from other non TI a related things so the duration of the transient vision loss is super important because most ischemic events are seconds to minutes so things that last hours to days those aren't really amaurosis fugax because if you really had a transient vision loss from a lack of blood flow from your carotid to the central arteries or three days well that's not going to be transient anymore so the retina has a limited capacity to recover from ischemia so if it's three days long or three months long that that's not transient even if it gets better that's way more likely the optic neuritis that recovery so the duration is important if we'd like to have it be seconds to minutes if it's ischemia once you start getting two hours at a time it's extremely unlikely that an ischemic event that lasts more than two hours is going to be reversible in the eye same thing with the duration for the bilateral however in the transient monocular vision loss from TI a carotid disease on the ipsilateral side is the most likely cause and if it's transient and bilateral then we're going to be thinking about the vertebral basilar system and not the carotid system obviously either could be cardiogenic could come from your heart and those cardiogenic ideologies are usually atrial fibrillation in older patients but it could be valvular disease bacterial endocarditis arrhythmias of different types and tumors in your heart like a chole myxoma so they are gonna have to have an echo carotid Doppler and everybody's with a TI a from an erosive see Jax is gonna have an MRI because we're looking for silent ischemia and that's gonna be seen on DWI which in another video we covered diffusion-weighted imaging and how that could be ischemia hyper acute ischemia causing restricted diffusion so we're really going to be working up amaurosis fugax of seconds two minutes at a time as if it's a TI a looking at the carotid of its unilateral vertebral Basler and the heart doing an MRI scan some of these patients are going to need a hypercoagulable state workup but really you're going to be deferring all of that to the stroke team and let them handle it the best-case scenario is if it matches the prototype so the prototype for ischemia normally respects the vertical or horizontal meridians so if it's a curtain coming down from the top altitude until an onset that's a very good symptom that it's TIAA because the blood supply of the optic nerve or the retina is top half and bottom half or if the curtain comes in from the side that's suggested to mean Opik in patients who have homonymous hemianopia sometimes say it's in only in one eye even though what they meant to say was one side so you can't be fooled by the one eye-to-eye thing based on the history alone so if they say it's a curtain it lasts minutes at a time and it goes away in seconds two minutes we really should be thinking about taa the last thing I'll leave you with is another symptom that is highly sensitive and specific for carotid disease which is if it's retinal claudication and so you've heard about jaw claudication if you use your jaw it hurts that's the sign of ischemia and cansel in your jaw retinal claudication is the same but instead of pain what they get is they lose lose their vision from lighting condition chain so if they see a bright light then they have time don't have time to recover and that is a retinal ischemia sign the light induces a claudication event so altitude '''l onset or disappearance minutes at a time and duration or retinal claudication those are the symptoms in the Dutch amaurosis fugax study that it might be a TI a from ipsa lateral hemodynamically significant carotid disease and then lastly you should be thinking about it a sed rate and a CRP as well as workup in consideration for join cell in every amaurosis fugax in an elderly patient