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January 23, 2018; 90 (4) Resident and Fellow Section

Teaching NeuroImages: Visual loss as a rare complication of mechanical thrombectomy

Manuel Bolognese, Alexander von Hessling, Florian Jordi
First published January 22, 2018, DOI: https://doi.org/10.1212/WNL.0000000000004863
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A 46-year-old woman was admitted to the emergency department with a severe left hemispheric syndrome (NIH Stroke Scale [NIHSS] 11). CT showed an occlusion of the left middle cerebral artery, reaching from the distal main trunk (M1) to the inferior division (M2) (figure 1). IV thrombolysis was started and mechanical thrombectomy performed successfully. Postinterventional clinical examination showed mild aphasia (NIHSS 1). However, the patient also complained about impaired (“foggy”) vision of the left eye.

Figure 1
Figure 1 Neuroimaging (digital subtraction angiography, MRI) in acute stroke after middle cerebral artery (MCA) occlusion

Digital subtraction angiography shows clot in the left MCA before (A, arrows) and complete recanalization after thrombectomy (B). Follow-up diffusion-weighted imaging MRI (C) reveals small infarction in the left MCA territory.

Funduscopy showed retinal ischemia of the left eye without any persisting vessel occlusion (figure 2), most likely due to transient thromboembolism as a rare and uncommon complication of thrombectomy.1,2

Figure 2
Figure 2 Funduscopy

Unremarkable funduscopy of the right eye (A) compared to funduscopy of the left eye (B), which showed retinal hemorrhage and cotton-wool spots as a sign of retinal ischemia.

Author contributions

Manuel Bolognese: draft of the manuscript, primary clinical care of the patient. Alexander von Hessling: angiographic images of the patient, clinical care of the patient, revision of the manuscript. Florian Jordi: funduscopic images of the patient, clinical care of the patient, revision of the manuscript.

Study funding

No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Footnotes

References

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    6. Weber W
    . Complications of mechanical thrombectomy for acute ischemic stroke: a retrospective single-center study of 176 consecutive cases. Neuroradiology 2014;56:467–476.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Willinsky RA,
    2. Taylor SM,
    3. TerBrugge K,
    4. Farb RI,
    5. Tomlinson G,
    6. Montanera W
    . Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 2003;227:522–528.
    OpenUrlCrossRefPubMed

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