Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
Eur J Med Res. 2021 Jun 13;26(1):55. doi: 10.1186/s40001-021-00530-w.
Central retinal artery occlusion (CRAO) is an emergent ophthalmic disease which is commonly caused by atherosclerosis, thromboembolism, and arteriospasm. Here, we report a case of CRAO which is caused by extreme rare bilateral internal carotid artery (ICA) hypoplasia complicated with patent foramen ovale (PFO). The cardiogenic emboli blocked central retinal artery through unclosed foramen ovale and specific blood flow pathway.
This report describes a case of a 46-year-old woman sudden onset with amaurosis fugax for about 20 min and persistent visual impairment of left eye. Fundus fluorescein angiography shows the arm-retinal circulation time of left eye is 25 s, indicating that the occlusion occurs in the pathway from aortic arch to ophthalmic artery. The MRA and CTA examinations reveal the bilateral ICA hypoplasia and variation of Wills circle. Furthermore, transesophageal echocardiography (TEE) confirms the PFO and cardiogenic embolic event.
This work presents a CRAO case caused by rare congenital hypoplasia of ICA complicated with PFO, reminding us every single cause of vascular disease should be investigated carefully and the TOAST typing of cerebrovascular disease can be of great reference to the ocular vascular disease.
中央视网膜动脉阻塞（CRAO）是一种常见的眼科急症，通常由动脉粥样硬化、血栓栓塞和血管痉挛引起。在此，我们报告一例由罕见的双侧颈内动脉（ICA）发育不良合并卵圆孔未闭（PFO）引起的 CRAO 病例。心源性栓子通过未闭的卵圆孔和特定的血流途径阻塞中央视网膜动脉。
本报告描述了一例 46 岁女性突发短暂失明约 20 分钟，左眼持续性视力丧失。眼底荧光血管造影显示左眼臂-视网膜循环时间为 25 秒，提示阻塞发生在主动脉弓至眼动脉的通路中。MRA 和 CTA 检查显示双侧 ICA 发育不良和 Willis 环变异。此外，经食管超声心动图（TEE）证实存在 PFO 和心源性栓塞事件。
本研究报告了一例由罕见的先天性 ICA 发育不良合并 PFO 引起的 CRAO 病例，提醒我们应仔细检查每一个血管疾病的病因，对脑血管疾病的 TOAST 分型对眼部血管疾病具有重要的参考价值。
