Seetge Jessica, Cséke Balázs, Karádi Zsófia Nozomi, Szalai Eszter, Gaál Valéria, Szapáry László
Stroke Unit, Department of Neurology, University of Pécs, 7624 Pécs, Hungary.
Department of Emergency Medicine, University of Pécs, 7624 Pécs, Hungary.
Neurol Int. 2024 Dec 26;17(1):3. doi: 10.3390/neurolint17010003.
Acute retinal ischemia, including central retinal artery occlusion (CRAO), is recognized as a stroke equivalent by the American Heart Association/American Stroke Association (AHA/ASA), necessitating immediate multidisciplinary evaluation and management. However, referral patterns among ophthalmologists remain inconsistent, and evidence-based therapeutic interventions to improve visual outcomes are currently lacking. CRAO is associated with a significantly elevated risk of subsequent acute ischemic stroke (AIS), particularly within the first week following diagnosis, yet the role of intravenous thrombolysis (IVT) in this setting remains controversial. This case report presents a unique case of CRAO with concurrent internal carotid artery (ICA) occlusion, followed by an AIS affecting the middle cerebral artery (MCA). An 83-year-old woman presented with acute, painless monocular vision loss to the emergency department. IVT was administered within 4.5 h of admission for suspected CRAO associated with ICA occlusion (ICAO) identified on CT-angiography (CTA). One hour post-thrombolysis, CT-perfusion (CTP) confirmed MCA occlusion (MCAO), necessitating mechanical thrombectomy (MT). Successful recanalization was achieved without complications, and the patient demonstrated no functional impairments at discharge. This case underscores the importance of maintaining a vigilant approach to stroke management in CRAO patients. It highlights the diagnostic challenges encountered in clinical practice and advocates for further research into the role of IVT in CRAO cases with ICAO, emphasizing the need for consensus in treatment.
急性视网膜缺血，包括视网膜中央动脉阻塞（CRAO），被美国心脏协会/美国卒中协会（AHA/ASA）视为等同于卒中，需要立即进行多学科评估和管理。然而，眼科医生之间的转诊模式仍然不一致，目前缺乏改善视力预后的循证治疗干预措施。CRAO与随后发生急性缺血性卒中（AIS）的风险显著升高相关，尤其是在诊断后的第一周内，但静脉溶栓（IVT）在这种情况下的作用仍存在争议。本病例报告呈现了一例独特的CRAO合并颈内动脉（ICA）阻塞，随后发生影响大脑中动脉（MCA）的AIS的病例。一名83岁女性因急性无痛性单眼视力丧失到急诊科就诊。因CT血管造影（CTA）发现疑似与ICA阻塞（ICAO）相关的CRAO，在入院后4.5小时内给予了IVT。溶栓后1小时，CT灌注（CTP）证实存在MCA阻塞（MCAO），需要进行机械取栓（MT）。成功实现再通且无并发症，患者出院时无功能障碍。本病例强调了对CRAO患者的卒中管理保持警惕的重要性。它突出了临床实践中遇到的诊断挑战，并倡导进一步研究IVT在合并ICAO的CRAO病例中的作用，强调治疗方面达成共识的必要性。
