OPHTHALMOLOGIC MANIFESTIONS OF INTERNAL CAROTID-ARTERY DISSECTION

PURPOSE: To report the ophthalmologic symptoms and signs associated wi th extracranial internal carotid artery dissection. METHODS: One hundr ed forty-six consecutive patients with extracranial internal carotid a rtery dissection were evaluted; 29 were studied retrospectively from 1 972 to 1984 and 117 prospectively from 1985 to 1997. RESULTS: Sixty tw o percent of patients (91/146) with extracranial internal carotid arte ry dissection had ophthalmologic symptoms or signs that were the prese nting symptoms or signs of dissection in 52% (76/146). Forty-four perc ent (65/146) had painful Horner syndrome, which remained isolated in h alf the cases (32/65). Twenty eight percent (41/146) had transient mon ocular visual loss, which was painful in 31 cases, associated with Hor ner syn drome in 13 cases, and described as ''scintillations'' or ''fl ashing lights''-often related to postural changes or exposure to brigh t lights-suggesting acute choroidal hypoperfusion in 23 cases, Four pa tients had ischemic optic neuropathy; one had diplopia. Among the 76 p atients with ophthalmologic symptoms or signs as the presenting featur es of carotid dissection, a nonreversible ocular or hemispheric stroke later occurred in 27, within a mean of 6.2 days (range, 1 hour to 31 days). Eighteen patients had a stroke within the first week after the onset of neuro-ophthalmic symptoms and signs, and 24 had a stroke with in the first 2 weeks. CONCLUSION: Ophthalmologic symptoms or signs are frequently associated with and are often the presenting features in i nternal carotid artery dissection. Painful Horner syndrome or transien t monocular visual loss should prompt investigations to diagnose carot id artery dissection and begin early treatment to prevent a devastatin g ocular or hemispheric stroke. (Am J Ophthalmol 1998;126:565-577. (C) 1998 by Elsevier Science Inc. All rights reserved.).