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Neurophthalmological Diagnosis

Gordon J. Gilbert, MD
JAMA. 1974;227(2):202. doi:10.1001/jama.1974.03230150050021.
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To the Editor.—  In your QUESTIONS AND ANSWERS of Oct 15 (226:364, 1973), Dr. William Conway's 69-year-old patient experienced first a pain in his right eye and several days later acute onset of visual blurring in the same eye. Within the next few months he had several episodes of numbness on the right side of his body. Dr. Conway asked what further studies should be done, and your consultant, Dr. David Shoch, recommended a careful neurophthalmological examination with particular attention to the visual fields.Presumably, a careful neurophthalmological examination would include auscultation for bruits over the carotid arteries and orbits; it seems particularly important to rule out bilateral internal carotid artery stenosis. The patient's attack of right-sided numbness would be consistent with left carotid stenosis with cerebral microemboli, while the attack of acute right amaurosis would be consistent with a similar process involving the right internal carotid artery. Monocular amblyopia


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