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Mazzeo TJMM, Freire RCM, Filho LF, Machado CG, Gomes AMV. Central retinal artery occlusion secondary to presumed traumatic carotid artery dissection in a healthy child. Int J Retina Vitreous 2022; 8:56. [PMID: 35986425 PMCID: PMC9392279 DOI: 10.1186/s40942-022-00411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe a rare case of a 13 years-old healthy child that presented CRAO secondary to carotid artery dissection, which occurred after a neck rotation movement. Methods Case report with prospective literature review. Patients One patient described in the case report. Results Not applicable. Discussion/conclusion Internal carotid artery dissection is a rare condition, specially in children, that can lead to serious cerebral-ocular ischemic events. It may occur due to direct vessel trauma or spontaneously. Prompt imaging screening is of paramount importance because early antithrombotic treatment or surgical intervention may significantly reduce the incidence of devastating ischemic events, such as stroke or central retinal artery occlusion.
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Song JX, Lin XM, Hao ZQ, Wu SD, Xing YX. Ocular manifestations of internal carotid artery dissection. Int J Ophthalmol 2019; 12:834-839. [PMID: 31131245 DOI: 10.18240/ijo.2019.05.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Abstract
Internal carotid artery dissection (ICAD) results from disruption of the intima of the arterial wall, and can lead to intrusion of blood into the arterial wall and form an intramural hematoma. The hematoma can compress the true lumen of the vessel, causing functional stenosis or occlusion. The classic triad signs of ICAD include pain in the ipsilateral neck, head and orbital regions; a (partial) Horner syndrome; and cerebral or retinal ischemia. However, not all ICAD patients present with this classic signs. In some cases, ocular manifestations are the initial (and sometimes the only) findings. We summarize the ocular manifestations associated with ICAD in 3 categories: visual symptoms, oculosympathetic palsy, and ocular motor nerve palsy.
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Affiliation(s)
- Jin-Xin Song
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China.,Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xue-Mei Lin
- Department of Neurology, the First Hospital of Xi'an; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Zhao-Qin Hao
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Song-Di Wu
- Department of Neurology, the First Hospital of Xi'an; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Yong-Xin Xing
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
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Kleinberg TT, Uretsky S, Flanders AE, Bilyk JR, Murchison AP. Black as night. Surv Ophthalmol 2014; 60:269-73. [PMID: 25311430 DOI: 10.1016/j.survophthal.2014.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/20/2022]
Abstract
A 30-year-old man presented with painless total visual loss in the right eye. Fundus exam and imaging was consistent with total internal carotid artery occlusion and hemispheric stroke. The presentation and management options of retinal vascular occlusive disease in association with asymptomatic stroke are discussed.
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Affiliation(s)
| | - Scott Uretsky
- Division of Neuro-Ophthalmology, Neurological Surgery P.C., Lake Success, NY, USA
| | - Adam E Flanders
- Division of Neuroradiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jurij R Bilyk
- Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ann P Murchison
- Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
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Occlusion d’une branche artérielle rétinienne secondaire à une dissection carotidienne spontanée : à propos d’un cas. J Fr Ophtalmol 2014; 37:e79-80. [DOI: 10.1016/j.jfo.2013.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/24/2013] [Indexed: 11/30/2022]
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Patel M, Shah G, Davies JB, Mittra RA, Eliott D. Re-evaluating Our Perspective on Retinal Artery Occlusion from Carotid Dissection: A Report of Three Cases and Review of the Literature. Ophthalmic Surg Lasers Imaging Retina 2013; 44:555-60. [DOI: 10.3928/23258160-20130901-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 06/19/2013] [Indexed: 11/20/2022]
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Management of acute central retinal artery occlusion. ACTA ACUST UNITED AC 2008; 4:376-83. [PMID: 18542123 DOI: 10.1038/ncpneuro0811] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 03/27/2008] [Indexed: 11/09/2022]
Abstract
Central retinal artery occlusion (CRAO) is considered to be an acute stroke of the eye that results in profound visual loss. Spontaneous recovery rates are poor. Most CRAOs are caused by thromboembolism in the central retinal artery. Current standard therapies for CRAO that aim to restore perfusion to the retina and optic nerve head have not been shown to alter the natural course of the disease. Thrombolytic therapy for acute management of CRAO has shown promise in nonrandomized studies with regard to improving visual outcomes. A randomized controlled trial will be required to confirm the efficacy of thrombolytic therapy before it can be recommended for use in CRAO in daily clinical practice.
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Takaki Y, Nagata M, Shinoda K, Tatewaki S, Yamada K, Matsumoto CS, Hazuku T, Yamashita H, Ikebe T, Nakatsuka K. Severe acute ocular ischemia associated with spontaneous internal carotid artery dissection. Int Ophthalmol 2007; 28:447-9. [PMID: 17999033 DOI: 10.1007/s10792-007-9150-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 09/25/2007] [Indexed: 11/29/2022]
Abstract
A healthy 40-year-old man developed unilateral ocular ischemic syndrome as the only manifestation of a spontaneous internal carotid artery dissection.
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Affiliation(s)
- Yasuhiro Takaki
- Department of Brain and Neuroscience, Division of Sensory and Locomotive Science, Ophthalmology, Oita University Faculty of Medicine, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
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Skrapari I, Kagkelari E, Charitatos E, Pantelidaki C, Gounaris T, Sioula E. Acute painless monocular visual loss due to central retinal artery occlusion in a patient with Churg–Strauss vasculitis. Clin Rheumatol 2007; 27:125-7. [PMID: 17674118 DOI: 10.1007/s10067-007-0695-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 06/24/2007] [Accepted: 06/25/2007] [Indexed: 01/25/2023]
Abstract
Ocular involvement in Churg-Strauss syndrome (CSS) is infrequent. We describe a case of a 50-year-old woman, with blood eosinophilia, involvement of the respiratory tract, skin, and peripheral nervous system, fulfilling the American College of Rheumatology criteria for CSS, who presented with left foot drop followed by left acute painless visual loss. Central retinal artery occlusion was diagnosed by fundoscopic findings (retinal whitening with a cherry-red spot). CSS was confirmed by sural nerve biopsy. Despite treatment with high-dose corticosteroids, cyclophosphamide, and anticoagulant therapy, visual acuity was not substantially improved. Acute blindness in CSS has been rarely described. Even more rarely, central retinal artery occlusion has been found to be the underlying cause of this infrequent clinical manifestation in CSS.
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Affiliation(s)
- Ioanna Skrapari
- 1st Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece.
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Schneider U, Hermann A, Ernemann U, Bartz-Schmidt KU. CENTRAL RETINAL ARTERY OCCLUSION SECONDARY TO SPONTANEOUS INTERNAL CAROTID ARTERY DISSECTION. Retina 2004; 24:979-81. [PMID: 15580005 DOI: 10.1097/00006982-200412000-00027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ulrike Schneider
- University Eye Clinic Tübingen, Department I, Radiological Clinic, University Hospital Tübingen, Tübingen, Germany.
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Hwang JF, Chen SN, Chiu SL, Wu SL. Embolic cilioretinal artery occlusion due to carotid artery dissection. Am J Ophthalmol 2004; 138:496-8. [PMID: 15364244 DOI: 10.1016/j.ajo.2004.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 04/12/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To report a case of embolic cilioretinal artery occlusion caused by carotid artery dissection. DESIGN Interventional case report. METHODS A 38-year-old woman presented with acute visual loss in her right eye. Funduscopy showed a cilioretinal artery occlusion, which was confirmed by a fluorescein angiography. An embolus was found in the distal segment of the vessel. RESULTS Color Doppler images of right internal carotid artery (ICA) disclosed a pseudolumen, suggesting a diagnosis of carotid dissection. Retrobulbar color Doppler image showed relative low flow velocity in the ophthalmic artery without flow reversal. Magnetic resonance angiography and cerebral angiogram showed total occlusion of the right ICA. Follow-up visual field examination revealed an inferior central defect fed by the cilioretinal artery. CONCLUSION The pathogenesis of retinal artery occlusion caused by carotid dissection may be embolic or hemodynamic. In our case, a permanent visual defect was related to embolic occlusion of the cilioretinal artery.
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Affiliation(s)
- Jiunn-Feng Hwang
- Department of Ophthalmology, Cahghua Christian Hospital, 135 Nan-Siao Street, Chang-hua 500, Taiwan.
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Lubin J, Capparella J, Vecchione M. Acute monocular blindness associated with spontaneous common carotid artery dissection. Ann Emerg Med 2001; 38:332-5. [PMID: 11524656 DOI: 10.1067/mem.2001.116616] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The evaluation of patients with loss of vision is common in the emergency department. Central retinal artery occlusion (CRAO) is a potentially reversible cause of acute monocular blindness. When evaluating a patient with CRAO, the potential underlying causes should be considered while simultaneously initiating treatment. We present a case of spontaneous common carotid artery dissection manifesting as CRAO and propose that spontaneous carotid artery dissection be included in the differential diagnosis of CRAO.
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Affiliation(s)
- J Lubin
- Department of Emergency Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, RI 02903, USA.
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Abstract
Occlusions of the retinal arterial and venous circulations are common causes of severe visual decline and can affect all age groups. Acute retinal arterial obstruction is often associated with critical cerebrovascular and cardiovascular disease that may require systemic treatment. Retinal venous obstruction may be the presentation of significant systemic hypertension, diabetes mellitus, and a greater risk for cardiovascular morbidity. Additional metabolic and hematologic abnormalities have been identified in patients with retinal occlusive disease. The authors review recent advances in the study of systemic conditions associated with retinal vascular occlusions and offer guidelines for appropriate medical evaluation of patients with retinal occlusive disease.
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Affiliation(s)
- F M Recchia
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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