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Clinical Summary

Plaques, if present, are often found at arteriolar bifurcations. Patients may have signs and symptoms of vascular disease such as carotid bruits or stenosis, aortic stenosis, aneurysms, or atrial fibrillation. Amaurosis fugax, a transient loss of vision often described as a curtain of darkness obscuring vision with sight restoration within a few minutes, may be present in the history.

Cholesterol emboli (Hollenhorst plaques), associated with generalized atherosclerosis, often from carotid atheroma, are bright, highly refractile plaques. Platelet emboli (carotid artery or cardiac thrombus) are white and very difficult to visualize. Calcific emboli (cardiac valvular disease) are irregular and white or dull gray and much less refractile.

Management and Disposition

Referral for routine general medical evaluation is appropriate unless the patient presents with signs or symptoms consistent with showering of emboli, transient ischemic attack, or cerebrovascular accident, in which case admission should be considered.

Pearls

  1. Retinal emboli may produce a loss of vision, either transient or permanent in nature.

  2. Arteriolar occlusion may occur in either a central or a peripheral branch location.

  3. Occurrence of retinal emboli should prompt the clinician to search for an embolic source as the event may be a precursor to impending ischemic stroke.

FIGURE 3.9

Emboli. Refractile cholesterol plaques usually lodge at vessel bifurcations. (Photo contributor: William E. Cappaert, MD.)

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