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.
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.
Appendix Authors
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
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