Some Neuro-Ophthalmological Considerations in Cerebral Vascular Insufficiency

Abstract

Introduction Transient visual disturbances, blindness, homonymous hemianopsia, and diplopia are not infrequently important signs of cerebral vascular insufficiency. It has become evident that vascular insufficiency in various areas of the brain is the result of progressive reduction of blood flow by arteriosclerotic narrowing or obstruction of major vessels supplying the brain combined with transient periods of reduced systemic blood pressure (postural hypotension, cardiac arrhythmias, hypotensive drugs, etc.).¹ Syndromes of insufficiency of the major vessels of the brain are now better recognized and more clearly defined.² Recognition of these syndromes has been aided greatly by careful clinical study of the prodromal symptoms of patients who eventually developed strokes from complete occlusion of these vessels. The importance of occlusive disease of the extracranial portions of the cerebral vessels (approximately 25% of patients with symptoms of cerebrovascular insufficiency)³ is now widely recognized. Although the symptomatology of thrombosis of the carotid