1. © 2013 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section A 61-year-old patient with subacute blindness on the left eye

2. A 61-year-old vascular patient presented with headache and subacute blindness on the left eye. Remaining ACR-Criteria for temporal arteritis were negative. Sonography of temporal artery showed no “halo- sign”. Transorbital sonography was performed. Faissner et al. Vignette © 2013 American Academy of Neurology

3. Faissner et al. Imaging Left eye Right eye © 2013 American Academy of Neurology

4. Sonographic “retrobulbar spot sign” in differentiating aetiologies of sudden visual loss Transorbital sonography revealed hyperechogenic retrobulbar spot sign which is highly specific for embolic occlusion of central retinal artery. Comprehensive workup showed paroxysmal atrial fibrillation as potential reason for the embolus. Investigation for vasculitis was negative. Summarizing, potentially harmful thrombogenic administration of steroids could be avoided using transorbital sonography. Transorbital sonography may help in cases of sudden visual loss of unclear aetiology. Faissner et al. © 2013 American Academy of Neurology