[A case of amaurosis fugax with anomalous origin of the ophthalmic artery and atheromatous stenosis of the external carotid artery].

Amaurosis fugax associated with anomalous origin of the ophthalmic artery without occlusion of internal carotid artery is very rare. We are reporting such a case of amaurosis fugax with anomalous origin of the ophthalmic artery and atheromatous stenosis of the external carotid artery. A 49-year-old-man was referred to our neurosurgical clinic because of transient monocular blindness. The patient was diagnosed as carotid TIA and was treated within aspirin and dipyridamole. In spite of this treatment, he experienced further transient dimness of vision in the right eye, several times during a period of one month. On admission, general, physical and neurological examinations disclosed no abnormality except for a bruit over the right carotid artery. Platelet adhesiveness and aggregation were slightly elevated. Right common carotid angiogram showed marked stenosis of the origin of the external carotid artery and small "sail-like" plaque in the internal carotid sinus. The angiogram also demonstrated that the right ophthalmic artery was originated from the middle meningeal artery through the superior orbital fissure. Since choroid crescent was observed, all the branches of the ophthalmic artery including the central retinal artery were filled by the external carotid system. The right ophthalmic artery was never visualized by the selective internal carotid angiography. Subsequently right carotid endarterectomy was performed without complication. One year later he remains asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)