Central retinal artery occlusion preceding hemispheric ischemic stroke treated with mechanical thrombectomy: A case report.
XiaoYan Wen, Baoyi Guo, Xue Zeng et al.
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Case in brief
A 52-year-old man with dilated cardiomyopathy developed sudden, painless right-eye vision loss. Ophthalmologic examination and fluorescein angiography supported central retinal artery occlusion (CRAO). Nine days later, left-sided weakness and speech difficulty prompted evaluation; his NIHSS score was 8, and CT angiography showed right internal carotid artery occlusion from its origin. CT perfusion estimated an infarct core of 37 mL and penumbra of 186 mL. Mechanical thrombectomy with aspiration and adjunctive balloon angioplasty achieved expanded TICI 2c reperfusion. His NIHSS score was 2 at discharge; at 3 months, modified Rankin Scale score was 1, but right-eye visual loss persisted.
What made this case unusual
The CRAO preceded a hemispheric ischemic stroke by nine days, with subsequent identification of right internal carotid artery occlusion. This interval does not establish when the carotid occlusion or cerebral ischemia began.
Diagnostic / clinical pearl
CRAO may signal cerebrovascular or cardiac disease and warrants prompt evaluation; new neurological deficits require reassessment. The timing of retinal symptoms alone cannot establish the duration of carotid occlusion or cerebral ischemia.
Why it matters
The favorable outcome in this individual does not establish thrombectomy efficacy beyond 24 hours.