Central retinal artery occlusion with aphasia, secondary to internal carotid artery dissection in a young man

Abstract

Abstract Introduction: Central retinal artery occlusion (CRAO) is an ophthalmic emergency, requiring immediate diagnosis and treatment. CRAO usually causes severe loss of vision. We report a case of CRAO, secondary to an internal carotid artery dissection, in which there was a good prognosis owing to early intervention. Patient concern: A healthy 41-year-old man experienced sudden monocular loss of vision and transient aphasia. The light reflex was absent and fundus examination revealed an intra-arterial thrombus in his left eye. Diagnosis: CRAO and transient ischemic attack owing to internal carotid artery dissection. Intervention: The patient was treated with Anterior chamber paracentesis to decrease intraocular pressure and antithrombotic therapy for CRAO. Anticoagulation therapy was started after diagnosing internal carotid artery dissection. Outcome: The light reflex recovered and the patient's vision improved from no light perception to 20/20 after the anterior chamber paracentesis and antithrombotic therapy. Conservative treatment improved blood flow of the internal carotid artery, without recurrence of ischemic symptoms. Conclusion: CRAO requires urgent diagnosis and treatment to achieve a good visual outcome. It is also important to simultaneously test for systemic diseases and initiate appropriate treatment.