Muhammad Dawood Khan, A Hannan Masud, Zafar Ul Islam.
Thrombotic Internal Carotid Occlusion presenting as ipsilateral sudden Loss of Vision.
Pak J Ophthalmol Jan ;16(1):51-7.

A 42-year-old male reported to the Eye Department, CMH, Lahore, on 17 August, 1998 with 2 days history of painless, sudden, total loss of vision in the right eye. He was not a known diabetic or hypertensive. He gave up smoking two years ago, prior to which he was a heavy smoker. There was no past history of transient visual loss. Family history was not contributory. General physical and systemic examination revealed no abnormality. At the time of presentation, the right eye was PL positive in the temporal quadrant only. There was an afferent pupillary conduction defect. Funduscopy revealed a grayish-white retina with a classical cherry-red spot at the fovea and marked narrowing of the retinal arterioles. Examination of the left eye revealed no abnormality. The patient was diagnosed as a case of right CRAG and routine treatment was given. With the help of the cardiologist, a complete and thorough cardiovascular assessment was performed. Laboratory investigations revealed the patient to be a noninsulin dependent diabetic. Echocardiography dated 22nd Aug 1998 was within normal limits. However, Transoesophageal echocardiography (TOE) dated 10th September 1998 revealed thinckened but nonclacific aortic cusps. Doppler ultrasonography (USG) for the neck vesseles was reported to be normal. Transcranial doppler USG dated 27th August 1998 revealed increased flow in the left ICA, whereas right ICA was reported to be normal. CT Scan brain with contrast dated 29th August 1998 turned out to be normal. Therefore, MRI brain was advised (on 2nd October 1998) which revealed complete occlusion of right ICA with peripheral ischaemic changes related to the insult. Doppler studies of the neck vessels were repeated, this time confirming the total occlusion of the right ICA. Finally, the invasive investigation, i.e carotid angiography was asked for (on 12th October 1998) which revealed complete occlusion of the right ICA 1 cm from its grigin. The case was referred to a neurosurgeon and a vascular surgeon for endarterectomy which was not performed in this case due to recanalization. Presently he has vision of 5/60 and automated perimetry reveals a small residual temporal island in the right eye. The patient has developed optic atrophy. Slight symptomatic improvement noticed during 6 months of followup is possibly due to early retinal vascular recanalization.

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