Download A Patient With Acute Visual Loss and Transient

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CASE REVIEW: PRESENTATION
A Patient With Acute Visual
Loss and Transient Neurologic
Symptoms
Johnstone M. Kim, MD,1 Fadi Nahab, MD,2 Nancy J. Newman, MD,1,2,3
Valérie Biousse, MD1,2
Departments of 1Ophthalmology, 2Neurology, and 3Neurological Surgery, Emory University,
Atlanta, GA
A 73-year-old man presented with acute visual loss in his left eye associated with
transient left upper extremity numbness. Diagnosis was made in the emergency room,
where treatment strategies were discussed.
[Rev Neurol Dis. 2010;7(2/3):e89-e90 doi: 10.3909/rind0249a]
© 2010 MedReviews®, LLC
A
73-year-old right-handed white man presented to the emergency
department with new-onset transient left arm numbness lasting 1
minute and decreased vision in the left eye to the level of no light perception. His past medical history was notable for hypertension, prostate cancer
surgery without radiation or chemotherapy, and an episode of transient left arm
numbness 1 year prior, after which he had been placed on aspirin and clopidogrel. The stroke team was alerted and neurologic examination was remarkable
only for visual loss. Results of a head computed tomography scan without contrast were normal and the patient had no symptoms suggestive of giant cell
arteritis. The episode of transient left arm numbness was presumed to be related
to a right hemispheric transient ischemic attack.
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A Patient With Acute Visual Loss and Transient Neurologic Symptoms continued
soft to palpation. Dilated fundus
examination results were normal in
the right eye with a normal-appearing
optic disc and no retinal emboli. In
the left eye there was severe attenuation of the retinal arteries and
for 3 minutes to the left eye with
no change in vision or funduscopic
appearance.
What is the diagnosis and how
should this patient be evaluated
acutely?
In the left eye there was severe attenuation of the retinal arteries and
numerous whitish retinal emboli in all major arteries associated with
diffuse retinal edema and cherry red spot.
This work was supported in part by a
departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc. (New York, NY), and by core grant
P30-EY06360 (Department of Ophthalmology) from the National Institutes of Health
(Bethesda, MD). Dr. Newman is a recipient
of a Research to Prevent Blindness Lew R.
Wasserman Merit Award.
The ophthalmology department
was immediately consulted and documented visual acuity of 20/20 in
his right eye and bare hand motion
in his left eye. There was a dense left
relative afferent pupillary defect.
Extra ocular movements were full.
Results of an anterior segment examination of both eyes with penlight were normal. Both eyes were
numerous whitish retinal emboli in
all major arteries associated with
diffuse retinal edema and cherry red
spot. Ocular massage was performed
Please turn to page e98 for a diagnosis and discussion of this case.
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REVIEWS IN NEUROLOGICAL DISEASES