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7. RIND0249A_07-27.qxd 7/27/10 02:53 PM Page e89 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. VOL. 7 NO. 2/3 2010 REVIEWS IN NEUROLOGICAL DISEASES e89 7. RIND0249A_07-27.qxd 7/27/10 02:53 PM Page e90 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. e90 VOL. 7 NO. 2/3 2010 REVIEWS IN NEUROLOGICAL DISEASES