Transient Monocular Visual Loss: When Is It an Emergency?

BackgroundPatients who experienced transient monocular vision loss (TMVL) commonly present to the emergency department for evaluation. Although multiple etiologies can cause TMVL, it is most important to identify patients with retinal ischemia and those with vasculitis (giant cell arteritis) as the cause of TMVL. Patients with transient retinal ischemia have the same risk of cardiovascular events and death as patients who experienced transient brain ischemia. Patients with giant cell arteritis are at imminent risk of visual loss.Case ReportA 65-year-old man noticed three separate episodes of sudden onset of blurry vision in one eye. Ophthalmologic examination was normal but, as his symptoms were compatible with transient retinal ischemic attack, urgent investigations were initiated. He had normal inflammatory markers but computed tomography angiogram of the brain and neck demonstrated a large plaque in the ipsilateral internal carotid artery. Double anti-platelet therapy was started and stenting of the involved carotid artery was performed. The patient was symptom-free at the last follow-up.Why Should an Emergency Physician Be Aware of This?Patients with retinal ischemia as the etiology of TMVL are at high risk of cardiovascular events and death. Their risk of cerebrovascular accidents is highest within 48 h from the episode of TMVL, thus they should have an urgent ophthalmologic examination and, if it is unrevealing, inflammatory markers should be checked and an urgent stroke prevention protocol should be initiated. Appropriate management with medical or surgical interventions significantly reduces morbidity and mortality in these patients.     

Links between marital and parent-child interactions: moderating role of husband-to-wife aggression

The present study examined how marital conflict may compromise parenting by identifying interdependencies across marital and parent-child subsystems in a sample of 86 two-parent families with a child aged 9-13. The study used direct observation of three family discussions to examine interdependencies across family subsystems. The study also assessed whether a history of husband-to-wife aggression strengthened interdependencies. Overall, families with husband-to-wife aggression showed a negative tone that pervaded throughout the family. Consistent with theories about physically aggressive men tending to withdraw from conflict, fathers who had engaged in husband-to-wife aggression showed an association between marital hostilities and lower levels of empathy toward their children. Consistent with stress theories, women who had been exposed to husband-to-wife aggression showed a link between marital hostilities and negative affect when interacting with their children. These findings illustrate how a history of exposure to marital aggression can create a family environment of multiple risks for children. For children in families with prior marital aggression, ongoing marital hostilities can be linked to the additional risk of erosions in parental support.