Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Alzheimer’s Disease Amaurosis Fugax 103

follow-up

N/A

complications and prognosis

■Early diagnosis allows for planning

■Advanced stage of dementia may require nursing facility

■Prognosis: disease is chronic & progressive

Amaurosis Fugax....................................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Sudden onset of painless monocular blindness

■Clears within 30 min (usually 1–5 min)

■May be history of TIAs, especially contralateral limb weakness

■Microemboli may be present in retinal vessels

■May be evidence of peripheral vascular disease

■May be carotid bruit or cardiac source of emboli

tests

■Basic: CBC, differential count, ESR, PT, PTT, FBS, lipid profile, RPR,

electrolytes; consider also SPEP, fibrinogen, proteins C & S, ANA,

antiphospholipid antibody, antithrombin III, factor V Leiden

■Chest x-ray

■Cranial MRI; cranial & cervical MRA (may show evidence of diffuse

or localized vascular disease); carotid duplex ultrasonography may

reveal localized disease

■Cardiac studies: ECG, echo

differential diagnosis

■Other causes of transient monocular visual loss include papilledema,

refractive error, episodic hypotension, migraine, vasculitis, poly-

cythemia, coagulopathy; exclude them by history, physical exam or

tests as above

management

■Aspirin (optimal dose not established)

■Ticlopidine

■For cardiogenic embolism, initiate anticoagulant treatment w/ hep-

arin & introduce warfarin (to INR 2–3)