Retinal arteriolar occlusion in multiple sclerosis

A 25-year-old white man presented with acute multiple sclerosis manifested by right blindness, difficulty urinating, and paresthesias and weakness of both legs. Retinal examination revealed a distal occlusion of the descending branch of the superior temporal arteriole leading to an area of retinal ischemia of the right eye. The optic disc was edematous, and there were focal areas of periphlebitis. All retinal signs resolved in three weeks, and the only abnormality that persisted was a pale right optic disc. The finding of small arteriolar disease is unusual and may represent another possible pathogenetic mechanism in multiple sclerosis.