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Aktuelle Neurologie 2015; 42(10): 617-620
DOI: 10.1055/s-0035-1565102
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© Georg Thieme Verlag KG Stuttgart · New York

Rezidivierende monokulare Sehstörung bei hochgradiger Stenose der Arteria centralis retinae. Diagnose mit orbitaler Farbduplexsonografie

Diagnosis of Recurrent Monocular Blindness in High-Grade Stenosis of the Central Retinal Artery with Color Duplex Sonography
H. Kazarians
1   Neurologie und Neurogeriatrie, Asklepios Klinik Wandsbek, Hamburg
,
C. Arning
2   Praxis, Neurologie und Neuroultraschall, Hamburg
,
L. Marquardt
1   Neurologie und Neurogeriatrie, Asklepios Klinik Wandsbek, Hamburg
2   Praxis, Neurologie und Neuroultraschall, Hamburg
› Author Affiliations
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Publication History

Publication Date:
07 December 2015 (online)

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Zusammenfassung

Die hämodynamische Variante der Amaurosis fugax wird nicht durch einen passageren vollständigen Verschluss sondern durch eine kritische Minderperfusion der A. centralis retinae verursacht. Auslöser sind meist hochgradige Stenosen der proximalen A. carotis interna. Der dargestellte Fall zeigt als eine weitere, seltene Differenzialdiagnose eine symptomatische hochgradige, hämodynamisch relevante potentiell embolisch bedingte, nicht vaskulitische Stenose der distalen Zentralarterie als Ursache fluktuierender monokulärer Sehstörungen. Die orbitale Farbduplexsonografie von retrobulbären Arterien ermöglicht durch multimodale Gefäßbeurteilung eine präzise, reliable und zum therapeutischen Monitoring einfach reproduzierbare Darstellung einer symptomatischen Zentralarterienstenose. Unter individueller Behandlung auf Grundlage der vaskulären Ultraschallbefunde mit anfangs toleriertem Erfordernishochdruck zur Sicherung einer hämodynamisch ausreichenden retinalen Blutversorgung und sekundärprophylaktischer einfacher Thrombozytenfunktionshemmung traten keine weiteren Sehstörungen mehr auf. Die hämodynamisch relevante Zentralarterienstenose bildete sich im Sinne einer vollständigen Rekanalisation innerhalb von 4 Wochen anhaltend und vollständig zurück. Evidenzbasierte Therapien einer symptomatischen Zentralarterienstenose liegen bislang wie auch beim embolisch verursachten Zentralarterienverschluss nicht vor, so dass prospektive Studien zur Evaluation einer standardisierten Behandlung dieses vaskulären Notfalls erforderlich sein werden.

Abstract

The hemodynamic amaurosis fugax is not caused by complete occlusion, but a significantly altered and decreased flow in the central retinal artery. Most commonly, this is caused by high-grade stenosis of the proximal internal carotid artery. The case presented here documents a further but rare differential diagnosis of recurrent transient monocular blindness, namely a hemodynamically relevant, symptomatic and high-grade stenosis of the distal central retinal artery of non-vasculitic but probably of embolic origin. Orbital color duplex sonography of the central retinal artery is shown to be a powerful diagnostic tool to confirm the hemodynamic relevance of this special pathology in retrobulbar and retinal arteries. Ultrasound investigation enables monitoring of therapeutic effects due to its high reliability. Based on ultrasound findings, the patient was treated for hypertension to ensure sufficient retinal blood supply, which was initially well tolerated and administered a single platelet inhibitor for secondary prevention; this treatment led to complete remission of ocular symptoms. Within a follow-up period of four weeks, there was a complete recanalization of the stenosis of the central retina artery. Because there are no generally established or evidence-based therapeutic concepts for symptomatic stenosis and occlusion of the central retina artery, further controlled trials will be necessary to establish a valid and standardized treatment for this vascular emergency.

Schlüsselwörter

hämodynamische Amaurosis fugax - Arteria centralis retinae - Stenose - Nervus opticus - transbulbäre Farbduplexsonografie

Keywords

hemodynamic amaurosis fugax - central retinal artery - stenosis - optic nerve - transbulbar color duplex sonography
 

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