Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine

Background Retinal migraine is defined by fully reversible monocular visual phenomena. We present two cases that were complicated by permanent monocular vision deficits. Cases A 57-year-old man with history of retinal migraine experienced persistent monocular vision loss after one stereotypical retinal migraine, progressing to finger-count vision over 4 days. He developed paracentral acute middle maculopathy that progressed to central retinal artery occlusion. A 27-year-old man with history of retinal migraine presented with persistent right eye superotemporal scotoma after a retinal migraine. Relative afferent pupillary defect and superotemporal visual field defect were noted, consistent with ischemic optic neuropathy. Conclusion Retinal migraine can complicate with permanent monocular visual loss, suggesting potential migrainous infarction of the retina or optic nerve. A thorough cerebrovascular evaluation must be completed, which was unrevealing in our cases. Acute and preventive migraine therapy may be considered in retinal migraine patients, to mitigate rare but potentially permanent visual loss.

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Unilateral Vision Loss without Ophthalmoplegia as a Rare Complication of Spinal Surgery

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_470_16 ◽

2017 ◽

Vol 08 (02) ◽

pp. 288-290 ◽

Cited By ~ 1

Author(s):

Elif Akpınar ◽

Mehmet Sabri Gürbüz ◽

Gülfidan Bitirgen ◽

Mehmet Özerk Okutan

Keyword(s):

Spinal Surgery ◽

Visual Loss ◽

Vision Loss ◽

Rare Complication ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Ischemic Optic Neuropathy ◽

Acute Visual Loss ◽

Retinal Artery

ABSTRACTPostoperative visual loss is an extremely rare complication of nonocular surgery. The most common causes are ischemic optic neuropathy, central retinal artery occlusion, and cerebral ischemia. Acute visual loss after spinal surgery is even rarer. The most important risk factors are long-lasting operations, massive bleedings, fluid overload, hypotension, hypothermia, coagulation disorders, direct trauma, embolism, long-term external ocular pressure, and anemia. Here, we present a case of a 54-year-old male who developed acute visual loss in his left eye after a lumbar instrumentation surgery and was diagnosed with retinal artery occlusion.

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Concurrent Bilateral Central Retinal Artery Occlusion Secondary to Sickle Cell Crisis

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211028392 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110283

Author(s):

Gowri Renganathan ◽

Piruthiviraj Natarajan ◽

Lela Ruck ◽

Roberto Prieto ◽

Bharat Ved Prakash ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Cell Disease ◽

Sickle Cell Crisis ◽

History Of ◽

Retinal Artery

Vascular occlusive crisis with a concurrent vision loss on both eyes is one of the most devastating disability for sickle cell disease patients. Reportedly occlusive crisis in the eyes is usually temporary whereas if not appropriately managed can result in permanent vision loss. A carefully managed sickle cell crisis could prevent multiple disabilities including blindness and stroke. We report a case of a 24-year-old female with a history of sickle cell disease who had acute bilateral vision loss during a sickle crisis and recovered significantly with a timely emergent erythrocytapheresis.

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Case Report: Central Retinal Artery Occlusion in a COVID-19 Patient

Frontiers in Pharmacology ◽

10.3389/fphar.2020.588384 ◽

2020 ◽

Vol 11 ◽

Author(s):

Andrea Montesel ◽

Claudio Bucolo ◽

Victoria Mouvet ◽

Emmanuelle Moret ◽

Chiara M. Eandi

Keyword(s):

Vision Loss ◽

Previous History ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

History Of ◽

Severe Vision Loss ◽

Retinal Artery ◽

Vascular Occlusions

We report a case of central retinal artery occlusion (CRAO) in a patient with a previous history of severe COVID-19 disease. This disease has been associated with inflammatory-induced homeostasis changes leading to endothelial dysfunction and a procoagulant state with multi-organ involvement, but the burden of thromboembolic complications in COVID-19 patients is currently unknown. The pathogenesis of retinal artery occlusions is a multifactorial process where inflammation and hypercoagulation state are established risk factors. Even if our experience may represent a coincidental relationship, it is likely that COVID-19 patients could be at risk of developing retinal vascular occlusions. A focused ophthalmological surveillance is advisable to prevent and manage this possible cause of severe vision loss that has an important impact in health care system.

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A Cardiac Pseudoaneurysm as a Thromboembolic Source: Acute Visual Loss due to Cardiac Emboli

Case Reports in Cardiology ◽

10.1155/2020/3192957 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Fernando Montenegro Sá ◽

Sara I. L. Fernandes ◽

Rita J. R. Carvalho ◽

Luís M. G. Santos ◽

José A. S. Antunes ◽

...

Keyword(s):

Aortic Valve ◽

Visual Loss ◽

Central Retinal Artery Occlusion ◽

Transoesophageal Echocardiography ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Acute Visual Loss ◽

History Of ◽

Retinal Artery

Acute visual loss is rarely caused by a heart condition. This manuscript transcribes a case report of a 36-year-old patient with a 2-year history of aortic valve replacement due to bicuspid aortic valve endocarditis that presents to the emergency department with an acute right eye visual loss. After ophthalmologic investigation identified a central retinal artery occlusion, a transthoracic echocardiography was performed to search for a possible cardiac embolus, despite the patient presenting INR values of 2-2.5 for the last year. A mitral-aortic intervalvular fibrosa pseudoaneurysm was identified. A transoesophageal echocardiography was then performed, identifying a small clot logged inside the pseudoaneurysm that protruded to the left ventricle outflow tract. After INR-adjusted warfarin treatment to levels between 3 and 4, the pseudoaneurysm was surgically closed. This is a rare case since the likely source of embolism to the central retinal artery was the thrombus logged inside the pseudoaneurysm despite a standardly accepted therapeutic INR.

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Odontogenic orbital cellulitis in a young man with complete vision loss – a case report

Pomeranian Journal of Life Sciences ◽

10.21164/pomjlifesci.746 ◽

2020 ◽

Vol 66 (4) ◽

pp. 41-45

Author(s):

Maciej Sikora ◽

Krzysztof Wróbel ◽

Agata Stąpor ◽

Marcin Sielski ◽

Dariusz Chlubek

Keyword(s):

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Lactobacillus Rhamnosus ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Pharmacological Therapy ◽

Orbital Cellulitis ◽

Ischemic Optic Neuropathy ◽

Resonance Test ◽

Retinal Artery

Abstract Odontogenic inflammation in humans can spread to adjacent anatomical structures, causing pathological changes that are dangerous to health and, in some cases, life. In this paper, we present an unusual case of odontogenic orbital cellulitis caused by both Lactobacillus rhamnosus and Enterococcus avium, which resulted in blindness of the eye in a 25-year-old man. Orbital cellulitis is more common in children due to the relative immaturity of their immune systems whereas it is rare in adults – in most cases, it occurs as a complication of paranasal sinusitis. An accurate diagnosis requires not only a thorough clinical examination but also appropriate imaging tests (such as a computed tomography or nuclear magnetic resonance test). Successful treatment largely depends on the earliest possible implementation of pharmacological therapy. In cases where it is justified, surgical procedures to decompress and drain the abscess should also be considered. However, in the case described in this publication, the patient did not regain vision in the affected eye despite the implementation of both intensive pharmacological treatment and surgical treatment, probably due to ischemic optic neuropathy and central retinal artery occlusion caused by severe infraorbital oedema.

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Abstract TP42: Risk of Acute Ischemic Stroke in Monocular Vision Loss of Vascular Etiology

Stroke ◽

10.1161/str.48.suppl_1.tp42 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jason Zhang ◽

Lucy Y Zhang ◽

Jared Matthews ◽

Danielle Rudich ◽

David Greer ◽

...

Keyword(s):

Ischemic Stroke ◽

Vision Loss ◽

Brain Mri ◽

Central Retinal Artery Occlusion ◽

Brain Magnetic Resonance Imaging ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Monocular Vision ◽

Neurologic Deficits ◽

Retinal Artery

Purpose: To evaluate the risk of concurrent acute cortical ischemic stroke in the setting of monocular vision loss of vascular etiology. Design: Retrospective and prospective, cross-sectional study. Subjects: Patients age 18 or older diagnosed with monocular vision loss of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain magnetic resonance imaging (MRI) within 7 days of onset of visual symptoms. Methods: Medical record review was performed from 2013-2016 at Yale-New Haven Hospital. Subjects were included if vision loss was unilateral, permanent or transient, and thought to be due to a vascular etiology such as central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO). Any subjects with neurologic deficits other than vision loss were excluded. Other exclusion criteria were positive visual phenomena, non-vascular intraocular pathology, and intracranial pathology other than ischemic stroke. Institutional Review Board/Ethics Committee approval was obtained. Main Outcome Measures: Presence or absence of acute cortical stroke on diffusion weighted imaging (DWI) sequence on brain MRI. Results: A total of 641 records were reviewed, with 293 subjects found to have monocular vision loss. After excluding subjects with focal neurologic deficits, there were 41 subjects who met inclusion criteria and received a brain MRI. 8 of the 41 subjects (19.5%) were found to have brain MRI positive for acute cortical strokes. The proportion of lesion positive MRI was 1/23 (4.3%) in transient monocular vision loss subjects, 4/12 (33.3%) in patients with CRAO, and 2/5 (40%) in BRAO. Conclusions: Patients with transient or permanent monocular vision loss of vascular etiology such as CRAO or BRAO may have up to 19.5% risk of concurrent cortical ischemic stroke, even when there are no other neurologic deficits. This highlights the importance of urgent stroke evaluation in this patient population.

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Postoperative Visual Loss in Spine Surgery

10.1093/med/9780190850036.003.0026 ◽

2018 ◽

Author(s):

David E. Traul

Keyword(s):

Risk Factors ◽

Spine Surgery ◽

Visual Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Cortical Blindness ◽

Ischemic Optic Neuropathy ◽

Cardiac Procedures ◽

Postoperative Visual Loss

Postoperative visual loss (POVL) is a rare but devastating condition associated with many types of nonocular surgery. In spine surgery, the most common causes of POVL are ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO), and cortical blindness. Although the association of POVL with spine surgery has long been recognized, the low incidence of this complication hinders the identification of patient and perioperative risk factors and limits our understanding of the causes of POVL. In adult spine surgery, POVL is most frequently attributed to ION whereas CRAO is more commonly seen in cardiac procedures. POVL due to cortical blindness has the highest incidence in pediatric spine surgery. While several risk factors for POVL have been identified in spine surgery, there are currently no standardized practice guidelines to eliminate the risk for POVL. Currently, there are no effective treatments for POVL, and recovery from ION and CRAO is limited.

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Current intraoperative devices to reduce visual loss after spine surgery

Neurosurgical FOCUS ◽

10.3171/2009.8.focus09151 ◽

2012 ◽

Vol 33 (2) ◽

pp. E14 ◽

Cited By ~ 12

Author(s):

Alberto A. Uribe ◽

Mirza N. Baig ◽

Erika G. Puente ◽

Adolfo Viloria ◽

Ehud Mendel ◽

...

Keyword(s):

Prone Position ◽

Spine Surgery ◽

Visual Loss ◽

Central Retinal Artery Occlusion ◽

Critical Factor ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Ocular Injury ◽

Ischemic Optic Neuropathy ◽

Advantages And Disadvantages

Postoperative visual loss (POVL) after spine surgery performed with the patient prone is a rare but devastating postoperative complication. The incidence and the mechanisms of visual loss after surgery are difficult to determine. The 4 recognized causes of POVL are ischemic optic neuropathy (approximately 89%), central retinal artery occlusion (approximately 11%), cortical infarction, and external ocular injury. There are very limited guidelines or protocols on the perioperative practice for “prone-position” surgeries. However, new devices have been designed to prevent mechanical ocular compression during prone-position spine surgeries. The authors used PubMed to perform a literature search for devices used in prone-position spine surgeries. A total of 7 devices was found; the authors explored these devices' features, advantages, and disadvantages. The cause of POVL seems to be a multifactorial problem with unclear pathophysiological mechanisms. Therefore, ocular compression is a critical factor, and eliminating any obvious compression to the eye with these devices could possibly prevent this devastating perioperative complication.

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Cytomegalovirus Retinal Necrosis With Occlusive Vasculopathy Secondary to Steroid Immunosuppression for Giant Cell Arteritis

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420908717 ◽

2020 ◽

Vol 4 (3) ◽

pp. 227-232

Author(s):

Anne Zeng ◽

Ron Strauss ◽

Sarah E. Goglin ◽

John Gonzales ◽

Varun K. Pawar ◽

...

Keyword(s):

Case Report ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Vision Loss ◽

Oral Prednisone ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Ischemic Optic Neuropathy ◽

The Right

Purpose: This case report discusses an atypical case of cytomegalovirus (CMV) retinal necrosis with panretinal occlusive vasculopathy in a 77-year-old man who was immunosuppressed following treatment for giant cell arteritis (GCA). Methods: A case report is presented. Results: Clinical examination demonstrated a central retinal artery occlusion and pale disc suspicious for arteritic ischemic optic neuropathy in the right eye. Biopsy-proven GCA prompted treatment with oral prednisone. While on glucocorticoid immunosuppression, the patient suffered vision loss in the left eye from CMV-necrotizing retinitis with occlusive vasculopathy. Treatment controlled the CMV infection but tapering of his steroids resulted in worsening GCA, requiring a steroid-sparing treatment, tocilizumab. Conclusions: Corticosteroid immunosuppression for GCA may lead to immune dysfunction allowing for an atypical occlusive vasculitis with retinal necrosis from CMV. Early identification and treatment are essential to adjust the level of immunosuppression and consider alternate therapies to control the GCA and prevent worsening of this opportunistic infection.

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The use of multimodal imaging in the evaluation of a patient with central retinal artery occlusion in the setting of asteroid hyalosis: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02774-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Timothy M. Janetos ◽

Olga German ◽

Rukhsana Mirza

Keyword(s):

Multimodal Imaging ◽

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Timely Diagnosis ◽

Cardiovascular Morbidity And Mortality ◽

Asteroid Hyalosis ◽

Retinal Artery

Abstract Background A central retinal artery occlusion (CRAO) is an ophthalmic emergency due to its strong association with cerebrovascular and cardiovascular morbidity and mortality. A timely diagnosis is necessary but difficult in the setting of dense asteroid hyalosis, as typical fundoscopic findings can be obscured. We present a case where multimodal imaging in an eye with an obscured fundus could lead to timely diagnosis and management of CRAO in a patient with acute vision loss. Case presentation A 94-year-old Caucasian woman with a history of exudative macular degeneration presented to the retina clinic with acute vision loss in one eye over the course of an afternoon. The patient had dense asteroid hyalosis, and a direct retinal exam was not possible. Multimodal imaging suggested a CRAO diagnosis. The patient received digital ocular massage directly prior to undergoing fluorescein angiography (FANG), which confirmed the diagnosis. The patient was transported from clinic to the emergency room for an emergency stroke workup, which revealed a spontaneous echo in the left atrial appendage, and the patient was started on antiplatelet therapy. When she presented for follow-up within a week, the patient noted that her vision had improved at the time of digital ocular massage and continued to improve thereafter. Her FANG showed marked reperfusion of the retina, and she subsequently has completely regained her baseline visual acuity. Conclusions Multimodal imaging is useful in evaluating visual loss in patients with acute vision loss. In addition, ocular massage is a simple, low-risk intervention that may have benefit in the treatment of acute CRAO. Patients who present to ophthalmologists with an acute CRAO need an emergency referral for evaluation of cerebrovascular and cardiovascular comorbidities.

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