![]() ![]() A chapter that pro motes angiography in patients with amaurosis fugax, particularly in those older than age 50 years, is certainly persuasive. A sig nificant chapter on computed tomographic scan ning demonstrates the extremely high incidence of silent cerebral infarction and atrophy in pa tients with amaurosis fugax. The section on workup includes chapters on noninvasive vascular examinations and useful descriptions of the current methods of studyingĮxtracranial and intracranial circulation. The section on the natural history of amaurosis fugax indicates that survival for affected males and females is less than the expected rate in a similar healthy population. Concluding this section is a good chapter on the roles of vascular spasm and ocular migraine and another on nonembolic sources of amaurosis fugax. It would benefit the entire field to term this phenomenon 'chronic ischemic retinopathy of carotid disease' and get on with other more important matters. It is unfortunate that Hayreh cannot concede this point, as it mars his otherwise stellar career and superlative writing. Nearly every other neuro-ophthalmologist worldwide views this in terpretation with considerable skepticism. In this chapter, Hayreh in sists that the ischemic retinopathy seen in some cases of severe carotid occlusive disease is a separate coexistent entity. Unfortunately, the subsequent chapter on the controversy of 'venous stasis retinopathy' is a fairly lucid but dogmatic and persistent pre sentation by a clinical professor of ophthalmol ogy (Hayreh) on a subject associated with carotid occlusive disease. The chapter on chronic ocular ischemia and carotid vascular disease is excel lent. His angiographic studies indicate that watershed areas and the posterior ciliary arteries are extremely important in the production of anterior ischemic optic neuropathy. One of the best chapters in the book is a contribution by Hayreh, in which he describes acute ischemia of the optic nerve. In a short chapter, Peter Savino confirms the original impression of Pfaffenbach and Hollenhorst concerning decreased survival in patients with visible retinal emboli. She subsequently describes occlusions of the central retinal artery. Shirley Wray discusses the vis ual aspects of extracranial carotid artery disease and lists the four types of amaurosis fugax. The photographs and fluorescein angiograms in this section are good. Unfortunately, this section also contains a printing error in the chapter on giant cell arteritis: the second para graph belongs in the previous section on occlu sions of the branches of the retinal veins. In the section on pathophysiologic considera tions, an interesting chapter describes angiog raphy of retinal and choroid vascular disease and several different types of emboli. ![]()
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