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Difficulty in articulation following left progressive blurred vision
An-Ting Lee1,2, Wei-Dar Chen2,3, Chien-Hsiung Lai2,3,4,5
1Department of Medical Education, Chang Gung Memorial Hospital, Chiayi.
European Journal of Ophthalmology
|April 12, 2021
Summary
Paracentral acute middle maculopathy (PAMM) can be an early warning sign of severe internal carotid artery (ICA) stenosis. This case highlights the importance of investigating ICA stenosis in patients presenting with PAMM.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Internal carotid artery (ICA) stenosis is a significant risk factor for cerebrovascular events.
- Paracentral acute middle maculopathy (PAMM) is an ischemic retinal condition affecting the inner nuclear layer.
- The association between PAMM and ICA stenosis is not well-established.
Observation:
- A 67-year-old male presented with acute blurred vision and was diagnosed with PAMM.
- Funduscopic examination revealed grayish patches around the macula, and OCT showed characteristic inner nuclear layer lesions.
- The patient subsequently developed dysarthria and was found to have severe left ICA stenosis and a lacunar infarction.
Findings:
- This case represents the first reported instance of PAMM co-occurring with lacunar infarction secondary to ICA stenosis.
- The patient's visual acuity and speech improved after anticoagulant therapy.
Implications:
- PAMM may serve as a critical indicator of underlying severe ICA stenosis.
- Ophthalmologists should consider evaluating for ICA stenosis in patients diagnosed with PAMM.
- Early detection of ICA stenosis through ophthalmological findings could prevent major vascular events.
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