OPHTHALMIC MANIFESTATIONS OF VERTEBRAL ARTERY DISSECTION - PATIENTS SEEN AT THE MAYO-CLINIC FROM 1976 TO 1992

Purpose: To determine the ophthalmic manifestations of vertebral arter y dissections. Methods: Fifty-one separate episodes of vertebral arter y dissections evaluated at the Mayo Clinic from 1976 through 1992 were studied. In all cases, the diagnosis had been documented with angiogr aphy. Results: There were 28 men and 19 women (mean and median age, 39 and 40 years, respectively; range, 8-61 years). There were ophthalmic findings in 86% of the episodes. Visual symptoms, in decreasing order of frequency, were diplopia (45% of the episodes), blurred vision (14 %), transient visual dimming (8%), oscillopsia (4%), photophobia (4%), upside-down vision (2%), positional transient visual obscuration (2%) , and unilateral dry eye (2%). Ophthalmic signs in decreasing order of frequency were nystagmus (37% of the episodes), ocular misalignment ( cranial nerve palsy or skew) (33%), Horner syndrome (27%), decreased c orneal sensation (22%), ptosis (16%), visual field defect (10%), abnor mal pursuits and saccades (6%), ocular bobbing (4%), internuclear opht halmoplegia (4%), anisocoria (4%), and pinpoint pupils (2%). Conclusio n: Vertebral artery dissections occur in a relatively young population . Most of the patients in our study had ophthalmic manifestations at t he time of diagnosis. Heightened awareness of this entity should enabl e the consulting ophthalmologist to have a role in the diagnosis and t reatment of vertebral artery dissection.