Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case Report
<b>Background/Objectives:</b> Acute retinal ischemia, including central retinal artery occlusion (CRAO), is recognized as a stroke equivalent by the American Heart Association/American Stroke Association (AHA/ASA), necessitating immediate multidisciplinary evaluation and management. Howe...
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2024-12-01
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| author | Jessica Seetge Balázs Cséke Zsófia Nozomi Karádi Eszter Szalai Valéria Gaál László Szapáry |
| author_facet | Jessica Seetge Balázs Cséke Zsófia Nozomi Karádi Eszter Szalai Valéria Gaál László Szapáry |
| author_sort | Jessica Seetge |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> Acute retinal ischemia, including central retinal artery occlusion (CRAO), is recognized as a stroke equivalent by the American Heart Association/American Stroke Association (AHA/ASA), necessitating immediate multidisciplinary evaluation and management. However, referral patterns among ophthalmologists remain inconsistent, and evidence-based therapeutic interventions to improve visual outcomes are currently lacking. CRAO is associated with a significantly elevated risk of subsequent acute ischemic stroke (AIS), particularly within the first week following diagnosis, yet the role of intravenous thrombolysis (IVT) in this setting remains controversial. This case report presents a unique case of CRAO with concurrent internal carotid artery (ICA) occlusion, followed by an AIS affecting the middle cerebral artery (MCA). <b>Case presentation:</b> An 83-year-old woman presented with acute, painless monocular vision loss to the emergency department. IVT was administered within 4.5 h of admission for suspected CRAO associated with ICA occlusion (ICAO) identified on CT-angiography (CTA). One hour post-thrombolysis, CT-perfusion (CTP) confirmed MCA occlusion (MCAO), necessitating mechanical thrombectomy (MT). Successful recanalization was achieved without complications, and the patient demonstrated no functional impairments at discharge. <b>Conclusions:</b> This case underscores the importance of maintaining a vigilant approach to stroke management in CRAO patients. It highlights the diagnostic challenges encountered in clinical practice and advocates for further research into the role of IVT in CRAO cases with ICAO, emphasizing the need for consensus in treatment. |
| format | Article |
| id | doaj-art-e79d2de2d4ce4ccb9c814d49494c3836 |
| institution | Kabale University |
| issn | 2035-8377 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Neurology International |
| spelling | doaj-art-e79d2de2d4ce4ccb9c814d49494c38362025-01-24T13:44:22ZengMDPI AGNeurology International2035-83772024-12-01171310.3390/neurolint17010003Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case ReportJessica Seetge0Balázs Cséke1Zsófia Nozomi Karádi2Eszter Szalai3Valéria Gaál4László Szapáry5Stroke Unit, Department of Neurology, University of Pécs, 7624 Pécs, HungaryDepartment of Emergency Medicine, University of Pécs, 7624 Pécs, HungaryStroke Unit, Department of Neurology, University of Pécs, 7624 Pécs, HungaryDepartment of Ophthalmology, University of Pécs, 7624 Pécs, HungaryDepartment of Ophthalmology, University of Pécs, 7624 Pécs, HungaryStroke Unit, Department of Neurology, University of Pécs, 7624 Pécs, Hungary<b>Background/Objectives:</b> Acute retinal ischemia, including central retinal artery occlusion (CRAO), is recognized as a stroke equivalent by the American Heart Association/American Stroke Association (AHA/ASA), necessitating immediate multidisciplinary evaluation and management. However, referral patterns among ophthalmologists remain inconsistent, and evidence-based therapeutic interventions to improve visual outcomes are currently lacking. CRAO is associated with a significantly elevated risk of subsequent acute ischemic stroke (AIS), particularly within the first week following diagnosis, yet the role of intravenous thrombolysis (IVT) in this setting remains controversial. This case report presents a unique case of CRAO with concurrent internal carotid artery (ICA) occlusion, followed by an AIS affecting the middle cerebral artery (MCA). <b>Case presentation:</b> An 83-year-old woman presented with acute, painless monocular vision loss to the emergency department. IVT was administered within 4.5 h of admission for suspected CRAO associated with ICA occlusion (ICAO) identified on CT-angiography (CTA). One hour post-thrombolysis, CT-perfusion (CTP) confirmed MCA occlusion (MCAO), necessitating mechanical thrombectomy (MT). Successful recanalization was achieved without complications, and the patient demonstrated no functional impairments at discharge. <b>Conclusions:</b> This case underscores the importance of maintaining a vigilant approach to stroke management in CRAO patients. It highlights the diagnostic challenges encountered in clinical practice and advocates for further research into the role of IVT in CRAO cases with ICAO, emphasizing the need for consensus in treatment.https://www.mdpi.com/2035-8377/17/1/3acute ischemic strokemonocular vision losscentral retinal artery occlusioninternal carotid artery occlusionintravenous thrombolysiscase report |
| spellingShingle | Jessica Seetge Balázs Cséke Zsófia Nozomi Karádi Eszter Szalai Valéria Gaál László Szapáry Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case Report Neurology International acute ischemic stroke monocular vision loss central retinal artery occlusion internal carotid artery occlusion intravenous thrombolysis case report |
| title | Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case Report |
| title_full | Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case Report |
| title_fullStr | Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case Report |
| title_full_unstemmed | Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case Report |
| title_short | Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case Report |
| title_sort | subsequent acute ischemic stroke in a patient with monocular vision loss associated with isolated internal carotid artery occlusion a case report |
| topic | acute ischemic stroke monocular vision loss central retinal artery occlusion internal carotid artery occlusion intravenous thrombolysis case report |
| url | https://www.mdpi.com/2035-8377/17/1/3 |
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