RETINAL ISCHEMIA AFTER FOCAL CEREBRAL ARTERIOPATHY IN A YOUNG GIRL

• Published in: Retinal cases & brief reports Vol. 18; no. 4; p. 503
• Main Authors: Benvenuto, Franco, Colorado-Zavala, Maria F, Ruiz-Lozano, Raul E, Gonzalez-Dutra, Maria L, Kadzielski, Carina, Ancona-Lezama, David
• Format: Journal Article
• Language: English
• Published: United States 01.07.2024
• Subjects: Carotid Artery, Internal - pathology; Child; Female; Humans; Ischemia - diagnosis; Ischemia - etiology; Retinal Diseases - diagnosis; Retinal Diseases - etiology; Tomography, Optical Coherence - methods
• ISSN: 1937-1578
• DOI: 10.1097/ICB.0000000000001422

We present a case of an ischemic retinopathy with severe vision loss secondary to a childhood stroke. Case report. An otherwise healthy 9-year-old girl presented with a 1-day history of impaired gait and speech. After performing computed tomography and magnetic resonance imaging, thrombosis of the left internal carotid artery was observed and a diagnosis of ischemic stroke was established. Serological autoimmune, coagulation, and viral panels were unrewarding. Cardiac, inflammatory, and coagulation disorders were ruled out. The cause was attributed to a focal cerebral arteriopathy, a common cause of childhood stroke. The patient was treated with mechanical thrombectomy followed by anticoagulation. The day after, the patient referred vision loss of 20/100 in the left eye. Fundus evaluation of the left eye depicted diffuse intraretinal hemorrhages and cotton-wool spots and there was retinal whitening at the posterior pole. Six weeks after, VA dropped to counting fingers. A macular optical coherence tomography revealed diffuse atrophic changes in the inner retinal layers at the macula, and the angio-optical coherence tomography showed an enlarged foveal avascular zone. We propose ischemia-reperfusion as the primary explanation of this unusual event.