Andrew Lloyd Webber - 12 Broadway Favorites by Andrew Lloyd Webber (Bb)
Sally Webber presentation on TIA
description
Transcript of Sally Webber presentation on TIA
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Sally Webber
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TRANSIENT VISUAL LOSS
What’s the most important feature?
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TRANSIENT VISUAL LOSS
Monocular or binocular?
Duration
Characteristics
Examination findings
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TRANSIENT VISUAL LOSS
Monocular or binocular?
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TRANSIENT VISUAL LOSS
Monocular or binocular?
Difficult as patients may report uniocular symptoms for migraine
Or patients may notice only the temporal side of a
homonomous visual field defect
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TRANSIENT VISUAL LOSS
Duration?
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TRANSIENT VISUAL LOSS
Visual obscurations
Amaurosis Fugax
Prolonged visual loss
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TRANSIENT VISUAL LOSS
Visual obscurations:
last seconds to minutes
Causes?
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TRANSIENT VISUAL LOSS
Visual obscurations: seconds to minutesCauses?
Lots!
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VISUAL OBSCURATIONS
Causes
Optic neuritis with Uhthoff’s phenomonenRetinal migrainePapilloedemaIntermittant angle closure glaucomaPituitary tumour
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VISUAL OBSCURATIONSSurface problems
○ Watery, dry, sticky
Vitreous floaters
Varifocals/bifocals/contact lenses
No obvious cause
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Diagnosis mainly needs
Careful history
and on examination?
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Examination tip
Usual ocular examination
IncludingIOPVisual fieldCareful check of the disc (dilate if possible)
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TRANSIENT VISUAL LOSS
Amaurosis Fugax
Duration?
Symptoms?
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Amaurosis Fugax
Lasts one to five minutes
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Amaurosis Fugax
Symptoms○ Over 50 years○ Complete loss all or part of Visual field○ ‘Like a curtain’○ Normal vision in other eye○ No systemic/neurological symptoms
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Amaurosis Fugax
• Examination• Vision, anterior segment and IOP• Visual field • Dilate pupils, look at disc, follow all retinal
arterioles to look for emboli
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Amaurosis Fugax
Ask about risk factors?
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Amaurosis Fugax
Ask about risk factors
○ Over 50 years○ Hypertension○ Diabetes○ Heart trouble, heart attack, angina○ Stroke, TIA
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Amaurosis Fugax
Management?
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Amaurosis Fugax
Management
○ Refer to GPAsk for Assessment for STROKE RISK FACTORS or
referral to the RUH STROKE CLINIC
○ Refer to Eye department to confirm diagnosis
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PROLONGED MONOCULAR VISUAL
LOSS
Fifteen to sixty minutes Causes
Hypertension and blood disorders‘Retinal migraine’
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PROLONGED VISUAL LOSS Fifteen to sixty minutes Causes
Hypertension and blood disorders‘Retinal migraine’
○ Rare, spasm of choroidal circulation○ Young adults○ Patchy/fading visual loss in one eye○ No positive visual phenomena○ No other neuro symptoms/signs
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TRANSIENT BINOCULAR VISUAL LOSS Migraine Bilateral disease, optic nerve/angle
closure Brain tumour or Arteriovenous
malfomation Vertibrobasilar TIA or insufficency
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MIGRAINE
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MIGRAINE Expanding
scintillating scotoma 10-30 mins Scotoma surrounded by
Zig-zagsFlashesSparklesWaves/watery
NORMAL EXAMINATION
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RETINAL ARTERY OCCLUSION
Embolus causing permenant occlusion
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RETINAL ARTERY OCCLUSION
Embolus causing permenant occlusion
Complete visual loss/dense scotoma
Pale retina
Embolus may be visible
Cherry red spot
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TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION?
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TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION Waiting
Dilation of the artery Sub-Lingual vasodialtorsRe-breathing expired carbon dioxide
Removal of physical obstruction Eye massage
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TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION
Increasing arterial perfusion pressure by reduction of intra ocular pressure
Anterior chamber paracentesis Intravenous DiamoxIntravenous Maritol
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THROMBOLISIS
Anti-platelet therapy Steroids Reducing red blood cells rigidity
Pentoxifylline has been tried
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Transient visual loss
Careful history
Visual fields
Check the discs
Remember the stoke clinic
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Thank you