**5. Conclusions**

**a.** slight decrease of PSV in PCAs (nasal and temporal) in the affected eye, compared to the

**b.** slight decrease of PSV in CRA of the affected eye, due to papillary edema (Figure 9 E., F.);

**c.** in OAs, PSV are variable: normal to decreased, according to ipsilateral ICAs status. Severe ICA stenosis (>70% of vessel diameter)/occlusion combined with an insufficient Willis

C D

E F

**Figure 9.** A. B. Pacient AN with nonarteritic-anterior ischemic optic neuropathy - Color Doppler Imaging of temporal posterior ciliary arteries (PCAs) of both eyes. Slight diminution of systolic blood flow velocities in temporal PCA in the affected left eye, compared to the normal side. C.D. Pacient AN with nonarteritic-anterior ischemic optic neuropathy - Color Doppler Imaging of nasal posterior ciliary arteries (PCAs) of both eyes. Slight diminution of systolic blood flow velocities in nasal PCA in the affected left eye, compared to the normal side. E. F. Pacient AN with nonarteritic-anterior ischemic optic neuropathy - Color Doppler Imaging of central retinal arteries of both eyes. Slight diminution of systolic

At one month, CDI examinations of orbital blood vessels reveal that blood flow normalization is reached. The exceptions are the cases with severe ipsilateral ICA stenosis/occlusion.

Consequently, in NA-AION, blood velocities and RI in PCAs are preserved. Similar results

B

unaffected eye (Figure 9 A., B., C., D.);

126 Updates in the Diagnosis and Treatment of Vasculitis

polygon led to decreased PSV in ipsilateral OA.

blood flow velocities in CRA of affected left eye, due to papilar edema.

were obtained in other studies [24-26].

A history of amaurosis fugax before an abrupt, painless, and severe loss of vision of the involved eye, with concomitant diffuse pale optic disc edema is extremely suggestive of A-AION. None of these symptoms are found in NA-AION patients.

Because findings of TAs US does not correlate with eye complications in A-AION patients, CDI of the retrobulbar vessels is of critical importance. It allows the detection and monitoring of alterations in orbital blood flow, especially of the PCAs, which corespond with the clinical features of A-AION.

Patients with clinical evidence of A-AION, who have typical signs on CDI of retrobulbar vessels, should be treated before TAB, with corticosteroids to protect against blindness of the fellow eye.

Although none of all presented criteria is individually infallible and present in one hundred percent of AION cases, the collective information provided by the various parameters is extremely helpful in diagnosis of A-AION or NA-AION.

### **Author details**

Dragos Catalin Jianu1\* and Silviana Nina Jianu2

\*Address all correspondence to: dcjianu@yahoo.com

1 University of Medicine and Pharmacy "Victor Babes", County Emergency Hospital De‐ partment of Neurology, Timisoara, Romania

[11] Taylor-Gjevre, R, Vo, M, Shukla, D, & Resch, L. Temporal artery biopsy for giant cell

Giant Cell Arteritis and Arteritic Anterior Ischemic Optic Neuropathies

http://dx.doi.org/10.5772/55345

129

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[21] Gonzalez-Gay, M. A, Garcia-Porrua, C, Llorca, J, Gonzalez-Louzao, C, & Rodriguez-Ledo, P. Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Semin. Arthritis Rheum. (2001). , 30, 249-56.

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2 Military Emergency Hospital Department of Ophthalmology, Timisoara, Romania


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**Chapter 6**

**Infectious Causes of Vasculitis**

Additional information is available at the end of the chapter

and diagnosing vasculitic disorders at the Chapel

diseases and were described by Jennette *et al.* [3]

definitions given in Table 3.

The vasculitides are a heterogeneous group of clinicopathological entities that share the common feature of vascular inflammation and injury. There is no universally acceptable classification of this group of disorders. While a number of underlying causes can be identified in some disorders, the aetiology is unknown in many. The pathogenetic mechanisms involved are mainly immunological, immune complex mediated tissue injury being the most commonly

In 1952, Zeek [1] became the first author to incorporate a clinicopathological assessment based on the size of the vessels involved in the inflammatory process in her classification of necrot‐ izing vasculitis. A number of alternative classification systems were proposed later and a major break was made in the 1990s with the 1990 American College of Rheumatology criteria (ACR 1990 criteria); and the elaboration of a uniform terminology for naming, defining, classifying

Hill Conference 1992 (1992 CHC definitions). The 1990 ACR criteria were reviewed in 1996 by Hunder [2]. The 1992 CHC definitions now include immunodiagnostically significant markers [e.g. ANCA in Wegener's granulomatosis (WG) and immunohistological findings (e.g. IgA‐ dominant immune deposits in Henoch–Schönlein purpura) which are specific for certain

The major problem with previous classification schemes was the lack of standardized diag‐ nostic terms and definitions. As a consequence, different names had been applied to the same disease and the same name to different diseases. Therefore, the CHC committee—comprised of internists, rheumatologists, nephrologists, immunologists and pathologists who have in common extensive experience with diagnosing vasculitides—proposed the names and

> © 2013 Choucair; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

Jacques Choucair

**1. Introduction**

incriminated factor.

**1.1. Infectious vasculitis**

http://dx.doi.org/10.5772/55189

[26] Tranquart, F, Aubert-urena, A. S, Arsene, S, Audrierie, C, Rossazza, C, & Pourcelot, L. Echo- Doppler couleur des arteres ciliaires posterieures dans la neuropathie op‐ tique ischemique anterieure aigue, J.E.M.U., (1997). , 18(1), 68-71.

**Chapter 6**
