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.
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
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
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Teaching slides: http://links.lww.com/WNL/A82
- Copyright © 2018 American Academy of Neurology
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