Headache and whiteout vision as the presenting symptoms in a case of Takayasu retinopathy

To report a case of Takayasu retinopathy presenting as chronic headache and whiteout of vision.

A case report of a 28-year-old woman with no medical history diagnosed with Takayasu retinopathy after a complete ophthalmologic examination, including widefield fluorescein angiography.

Dilated fundus examination revealed sharp margins in both eyes and mildly attenuated arterioles and distended veins. The peripheral examination was significant for several white-centered intraretinal hemorrhages. A widefield fluorescein angiogram showed numerous small microaneurysms in the periphery. A computer tomography angiogram of the chest showed central wall thickening of the aortic arch, proximal branch vessels of the aortic arch, including left common carotid and right common carotid, and middle lower lobe of the right pulmonary artery, all of which were consistent with the diagnosis of Takayasu disease. The patient underwent cardiovascular bypass surgery and her ocular symptoms resolved.

Up to one third of patients with Takayasu disease experience visual disturbances, and as a result, ophthalmologists may be the first physicians to encounter and diagnose this condition. The various stages of Takayasu retinopathy are characterized by dilation of small vessels, capillary microaneurysm formation, and development of arterial-venous anastomoses. The initial clinical presentation of Takayasu disease can be varied and nonspecific, therefore a high index of clinical suspicion is essential for diagnosis.