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August 16, 2022; 99 (7) Resident & Fellow Section

Teaching Video NeuroImage: Amaurosis Fugax Due to Recurrent Central Retinal Artery Occlusion by Microemboli

Viktor Weiss, Irena Doležalová, Tomáš Mňuk, Ivana Labounková, View ORCID ProfileRoman Herzig, View ORCID ProfileIgor Nestrašil
First published June 24, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200890
Viktor Weiss
From the Department of Neurology (V.W., I.D.), St. Anne's University Hospital and Medical School, Masaryk University, Brno; Charles University Faculty of Medicine (V.W.), Hradec Králové; Department of Ophthalmology (T.M.), St. Anne's University Hospital, Brno, Czechia; Division of Clinical Behavioral Neuroscience (I.L., I.N.), Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis; Department of Biomedical Engineering (I.L.), Brno University of Technology; and Department of Neurology (R.H.), Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia.
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Irena Doležalová
From the Department of Neurology (V.W., I.D.), St. Anne's University Hospital and Medical School, Masaryk University, Brno; Charles University Faculty of Medicine (V.W.), Hradec Králové; Department of Ophthalmology (T.M.), St. Anne's University Hospital, Brno, Czechia; Division of Clinical Behavioral Neuroscience (I.L., I.N.), Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis; Department of Biomedical Engineering (I.L.), Brno University of Technology; and Department of Neurology (R.H.), Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia.
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Tomáš Mňuk
From the Department of Neurology (V.W., I.D.), St. Anne's University Hospital and Medical School, Masaryk University, Brno; Charles University Faculty of Medicine (V.W.), Hradec Králové; Department of Ophthalmology (T.M.), St. Anne's University Hospital, Brno, Czechia; Division of Clinical Behavioral Neuroscience (I.L., I.N.), Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis; Department of Biomedical Engineering (I.L.), Brno University of Technology; and Department of Neurology (R.H.), Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia.
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Ivana Labounková
From the Department of Neurology (V.W., I.D.), St. Anne's University Hospital and Medical School, Masaryk University, Brno; Charles University Faculty of Medicine (V.W.), Hradec Králové; Department of Ophthalmology (T.M.), St. Anne's University Hospital, Brno, Czechia; Division of Clinical Behavioral Neuroscience (I.L., I.N.), Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis; Department of Biomedical Engineering (I.L.), Brno University of Technology; and Department of Neurology (R.H.), Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia.
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Roman Herzig
From the Department of Neurology (V.W., I.D.), St. Anne's University Hospital and Medical School, Masaryk University, Brno; Charles University Faculty of Medicine (V.W.), Hradec Králové; Department of Ophthalmology (T.M.), St. Anne's University Hospital, Brno, Czechia; Division of Clinical Behavioral Neuroscience (I.L., I.N.), Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis; Department of Biomedical Engineering (I.L.), Brno University of Technology; and Department of Neurology (R.H.), Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia.
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Igor Nestrašil
From the Department of Neurology (V.W., I.D.), St. Anne's University Hospital and Medical School, Masaryk University, Brno; Charles University Faculty of Medicine (V.W.), Hradec Králové; Department of Ophthalmology (T.M.), St. Anne's University Hospital, Brno, Czechia; Division of Clinical Behavioral Neuroscience (I.L., I.N.), Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis; Department of Biomedical Engineering (I.L.), Brno University of Technology; and Department of Neurology (R.H.), Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia.
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Teaching Video NeuroImage: Amaurosis Fugax Due to Recurrent Central Retinal Artery Occlusion by Microemboli
Viktor Weiss, Irena Doležalová, Tomáš Mňuk, Ivana Labounková, Roman Herzig, Igor Nestrašil
Neurology Aug 2022, 99 (7) 313-314; DOI: 10.1212/WNL.0000000000200890

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A previously healthy 71-year-old woman with hypercholesterolemia and current tobacco use presented with transient painless vision loss in the left eye without other neurologic abnormalities. The 30-second episodes, followed by a recovery, repeated in 2- to 3-minute intervals.1 Microemboli passing through central retinal artery (CRA) vasculature (Video 1) originated from a complicated atherosclerotic plaque in the left internal carotid artery (Figure). After receiving intravenous thrombolysis 5 hours after symptom onset,2 she reported a scotoma in the inferior part of her left eye, which persisted 2 years later. Retinal embolism from carotid artery disease is the most common cause of CRA occlusion.

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Figure CT Angiography, Fundus Image, and Perimetry

Nonstenotic, mixed (predominantly soft) atherosclerotic plaque (arrows) in the proximal left internal carotid artery with thin calcifications on CT angiography sagittal (A) and axial (B) slices. Reconstructed fundus image (C) showing microemboli (encircled yellow arrow). Perimetry at 3-month follow-up corresponding to the reported scotoma (D).

Video 1

Microemboli passing through the superior temporal branch of the central retinal artery. The video was acquired from an ocular slitlamp using hand-held cell phone camera with 20 frames per second (fps) sampling. Motion artifacts were suppressed with nonlinear image registration using Elastix libraries. The resampled 40-fps video was exported twice as slow.Download Supplementary Video 1 via http://dx.doi.org/10.1212/200890_Video_1

Study Funding

No targeted funding reported.

Disclosure

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

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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.

  • Submitted and externally peer reviewed. The handling editor was Whitley Aamodt, MD, MPH.

  • Teaching slides links.lww.com/WNL/C147

  • Received January 17, 2022.
  • Accepted in final form May 11, 2022.
  • © 2022 American Academy of Neurology

References

  1. 1.↵
    1. Fisher M
    . Occlusion of the internal carotid artery. AMA Arch Neurol Psychiatry. 1951;65(3):346-377.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Mac Grory B,
    2. Lavin P,
    3. Kirshner H,
    4. Schrag M
    . Thrombolytic therapy for acute central retinal artery occlusion. Stroke. 2020;51(2):687-695.
    OpenUrlCrossRefPubMed

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