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Valérie Biousse, MD; Monique Schaison, MD; Pierre-Jean Touboul, MD; Jacques D'Anglejan-Chatillon, MD; Marie-Germaine Bousser, MD

Arch Neurol. 1998;55:715-719.

Background  Ischemic optic neuropathy (ION) is an infarction of the anterior or, less frequently, posterior part of the optic nerve, usually due to a disease of small arteries supplying the optic nerve. Carotid stenosis or occlusions are rare causes, and among them, carotid dissections have been so far reported in only 5 cases.

Methods  We describe 4 patients with ION (2 anterior and 2 posterior) due to internal carotid artery dissection of a consecutive series of 110 patients with internal carotid artery dissection (3.6%).

Results  None of the patients had signs of central retinal artery occlusion or ischemic ocular syndrome. Ischemic optic neuropathy occurred after a mean of 5.3 days (range, 3-8 days) following the first symptom, which was headache in 1 patient, transient monocular blindness in 2, and hemispheric transient ischemic attack in 1. One patient had associated Horner syndrome, and 2 had severe ipsilateral headache and orbital pain. None of the patients developed a cerebral infarction. These features differ from those observed in "classic" nonarteritic anterior ION and might therefore point to carotid dissection.

Conclusion  Ischemic optic neuropathy may occur as an early sign of carotid dissection: young age, previous transient monocular blindness, an association with pain, Horner syndrome, or hemispheric transient ischemic attacks are suggestive of this cause and should prompt confirmatory investigations.

From the Departments of Neurology, Hôpital Lariboisière, Paris (Drs Biousse, Schaison, Touboul, and Bousser), and Hôpital de Versailles, Le Chesnay (Dr D'Anglejan-Chatillon), France.

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