RETINAL ISCHEMIA AFTER FOCAL CEREBRAL ARTERIOPATHY IN A YOUNG GIRL

We present a case of an ischemic retinopathy with severe vision loss secondary to a childhood stroke.

Case report.

An otherwise healthy 9-year-old girl presented with a 1-day history of impaired gait and speech. After performing computed tomography and magnetic resonance imaging, thrombosis of the left internal carotid artery was observed and a diagnosis of ischemic stroke was established. Serological autoimmune, coagulation, and viral panels were unrewarding. Cardiac, inflammatory, and coagulation disorders were ruled out. The cause was attributed to a focal cerebral arteriopathy, a common cause of childhood stroke. The patient was treated with mechanical thrombectomy followed by anticoagulation. The day after, the patient referred vision loss of 20/100 in the left eye. Fundus evaluation of the left eye depicted diffuse intraretinal hemorrhages and cotton-wool spots and there was retinal whitening at the posterior pole. Six weeks after, VA dropped to counting fingers.

A macular optical coherence tomography revealed diffuse atrophic changes in the inner retinal layers at the macula, and the angio-optical coherence tomography showed an enlarged foveal avascular zone. We propose ischemia-reperfusion as the primary explanation of this unusual event.