Ophthalmologic manifetion of internal carotid artery diection Original Reearch Article

PURPOE: To report the ophthalmologic ymptom and ign aociated with extracranial internal carotid artery diection. METHOD: One hundred forty-ix conecutive patient with extracranial internal carotid artery diection were evaluted; 29 were tudied retropectively from 1972 to 1984 and 117 propectively from 1985 to 1997. REULT: ixty-two percent of patient (91/146) with extracranial internal carotid artery diection had ophthalmologic ymptom or ign that were the preenting ymptom or ign of diection in 52% (76/146). Forty-four percent (65/146) had painful Horner yndrome, which remained iolated in half the cae (32/65). Twenty-eight percent (41/146) had tranient monocular viual lo, which wa painful in 31 cae, aociated with Horner yndrome in 13 cae, and decribed a “cintillation” or “flahing light”—often related to potural change or expoure to bright light—uggeting acute choroidal hypoperfuion in 23 cae. Four patient had ichemic optic neuropathy; one had diplopia. Among the 76 patient with ophthalmologic ymptom or ign a the preenting feature of carotid diection, a nonreverible ocular or hemipheric troke later occurred in 27, within a mean of 6.2 day (range, 1 hour to 31 day). Eighteen patient had a troke within the firt week after the onet of neuro-ophthalmic ymptom and ign, and 24 had a troke within the firt 2 week. CONCLUION: Ophthalmologic ymptom or ign are frequently aociated with and are often the preenting feature in internal carotid artery diection. Painful Horner yndrome or tranient monocular viual lo hould prompt invetigation to diagnoe carotid artery diection and begin early treatment to prevent a devatating ocular or hemipheric troke.