A 46 year old woman with visual loss after thrombectomy

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Presentation transcript:

A 46 year old woman with visual loss after thrombectomy Teaching NeuroImages Neurology Resident & Fellow Section © 2017 American Academy of Neurology

Vignette 46 year old woman Acute severe left hemispheric syndrome (NIHSS: 11) Computed tomography showed an occlusion of the left middle cerebral artery, reaching from the distal main trunk (M1) to the inferior divison (M2) Intravenous thrombolysis was started and mechanical thrombectomy successfully performed Postinterventional clinical examination showed mild aphasia (NIHSS: 1) However patient complained about impaired ("foggy") vision of the left eye Bolognese M, et al. © 2017 American Academy of Neurology

Neuroimaging Bolognese M, et al. Digital subtraction angiography showing clot in the left MCA before (A, arrows) and complete recanalization after thrombectomy (B).Follow up DWI MRI (C) revealed small infarction in the left MCA territory. Bolognese M, et al. © 2017 American Academy of Neurology

Fundoscopy Bolognese M, et al. Unremarkable fundoscopy of the right eye (A) compared to fundoscopy of the left eye (B) which showed retinal hemorrhage and cotton wool spots as a sign of retinal ischemia. Bolognese M, et al. © 2017 American Academy of Neurology

Visual loss as a rare complication of thrombectomy Fundoscopy showed retinal ischemia of the left eye without any persisting vessel occlusion Etiology: transient retinal thromboembolism as a rare and uncommon complication of thrombectomy 1,2 Behme D, Gondecki L, Fiethen S, Kowoll A, Mpotsaris A, Weber W. Complications of mechanical thrombectomy for acute ischemic stroke – a retrospective single-center study of 176 consecutive cases. Neuroradiology 2014;56(6):467-76 2) Willinsky RA, Taylor SM, terBrugge K, Farb RI, Tomlinson G, Montanera W. NeurologicComplications of Cerebral Angiography: Prospective Analysis of 2,899 Procedures and Review of the Literature. Radiology 2003;227(2):522-8 Bolognese M, et al. © 2017 American Academy of Neurology