Amaurosis fugax

This is an overview of publications concerning the risk of amaurosis fugax (AF) as a sign of cerebrovascular insufficiency and the risk of cerebral infarction in patients presenting with this symptom. AF is characterized by a sudden, painless, monocular loss of vision that typically lasts between 1 and 15 min. The patient frequently describes his vision as “dark” or “dim” and, generally, vision returns to normal immediatly after such an attack. The most common causes of AF are embolism, hemodynamics, or vasospasm. In 66% of cases the source of embolism was not detectable, in 27% it was likely to be caused by a carotid artery lesion, whereas a cardioembolic event was likely to be the source in only 2%. Most recent studies show that in patients with severe carotid stenosis (70% – 99%) and AF as the first presenting symptom, there is a 16% risk of stroke within a period of 2 years. This stroke risk is lower than in patients with transient ischemic attack as the presenting symptom, who are at a risk of 43% of stroke within 2 years. The risk of early mortality in older patients with AF is three to five times higher than in age-matched controls, with myocardial infarction as the major cause of death. In conclusion, the occurrence of AF carries a considerable risk of cerebral stroke and AF is a marker of generalized vascular disease.