Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Key Features ++ Essentials of Diagnosis ++ Sudden monocular loss of vision No pain or redness Widespread or sectoral retinal pallid swelling ++ General Considerations ++ In patients aged 50 years or older with central retinal artery occlusion, consider giant cell arteritis Carotid and cardiac sources of emboli must be sought so that treatment can be given to reduce the risk of stroke In young patients, causes include Migraine Oral contraceptives Systemic vasculitis Congenital or acquired hypercoagulable states (thrombophilia) (see below) Internal carotid artery dissection should be considered when there is neck pain or a recent history of neck trauma In all patients, consider Diabetes mellitus Hyperlipidemia Systemic hypertension ++ Clinical Findings ++ Symptoms and Signs ++ Central retinal artery occlusion Presents as sudden profound monocular visual loss Visual acuity is usually reduced to counting fingers or worse Visual field is restricted to an island of vision in the temporal field Branch retinal artery occlusion May also present with sudden loss of vision if the fovea is involved, but more commonly sudden loss of visual field is the presenting complaint Fundal signs of retinal swelling and adjacent cotton-wool spots are limited to the area of retina supplied by the occluded artery Identify risk factors for a cardiac source of emboli including arrhythmia, particularly atrial fibrillation, and cardiac valvular disease; and check the blood pressure Clinical features of giant cell arteritis include Jaw claudication (which is very specific) Headache Scalp tenderness General malaise Weight loss Polymyalgia rheumatica: shoulder and hip girdle pain Tenderness or thickening of, or absence of pulse in, the superficial temporal arteries ++ Diagnosis ++ Laboratory Tests ++ Test for diabetes (fasting serum glucose, hemoglobin A1C) and hyperlipidemia (fasting serum cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) in all patients Erythrocyte sedimentation rate and C-reactive protein are usually markedly elevated in giant cell arteritis but one or both may be normal Consider testing for other types of vasculitis (eg, antinuclear antibody, rheumatoid factor, anticytoplasmic neutrophil antibody) In younger patients, consider tests for congenital or acquired hypercoagulable states (thrombophilia) Antiphospholipid antibody syndrome (lupus anticoagulant) Activated protein C resistance/Factor V Leiden Protein C, protein S deficiency Antithrombin deficiency Hyperprothrombinemia (G20210A prothrombin gene mutation) Increased Factor VIII activity Hyperhomocysteinemia ++ Imaging Studies ++ Obtain duplex ultrasonography of the carotid arteries, ECG, and echocardiography (with transesophageal echocardiography, if necessary), to identify carotid and cardiac sources of emboli When indicated, obtain CT or MR angiography studies for internal carotid artery dissection ++ Diagnostic Studies ++ Central artery occlusion: Ophthalmoscopy Reveals pallid swelling of the retina with a cherry-red spot at the fovea The retinal arteries are attenuated, and "box-car" segmentation of blood may be seen in the retinal veins Occasionally, emboli are seen in the central retinal artery or its branches Optical ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options