Postprandial Transient Visual Loss: A Symptom of Critical Carotid Stenosis

Abstract

The authors report the association of transient visual loss after eating meals with severe carotid occlusive disease, and propose a hypothesis for its pathophysiology. Description of clinical history and examination, radiologic and other studies in two patients with postprandial transient visual loss, and review of the literature for three related cases. Two women, 59 and 65 years of age, presented with splotchy visual loss lasting up to more than 1 hour in the left and both eyes, respectively. In both patients, the visual loss was precipitated by eating a meal. Radiologic investigations revealed 90% stenosis of the left internal carotid artery in the first patient and occlusion of the right internal carotid artery and 40% to 70% stenosis of the left internal carotid artery in the second patient. Visual loss after eating a meal may result from hypoperfusion of the retinal and choroidal circulations and is suggestive of severe carotid occlusive disease.