Amalric choroidal infarction, retinal artery occlusion, and ischemic optic neuropathy: Delayed presentations of...

This case report describes the delayed, uncommon ophthalmic presentations of monocular choroidal ischemia (Amalric triangular sign), ischemic optic neuropathy, central retinal artery occlusion (CRAO), and extraocular motility restriction caused by traumatic internal carotid artery dissection (ICAD) in a young individual.

A 29-year-old man presented with sudden vision loss in his left eye which had started 7 h earlier. His medical history included a motorcycle accident six months prior, where he struck his chin on the ground and lost consciousness. At that time, he had completely recovered with no complications. On the day the patient reported with vision problem, an ophthalmic examination of the affected eye revealed visual acuity of no perception of light (NPL), restriction of extraocular movement, and relative afferent pupillary defect. Fundus examination showed slightly pale optic disc swelling, macular whitening with a cherry red spot appearance indicating the presence of CRAO, and several whitish triangular patches in the peripheral retina. Fundus fluorescein angiography revealed delayed arm to choroidal and retinal circulations in the early phase, with hyperfluorescence and hyperfluorescent staining along the areas of whitening triangular patches in the later phase. Carotid doppler ultrasonography and magnetic resonance angiography confirmed an extracranial left ICAD. After the 3-month follow up, the patient's vision remained NPL with hypo/hyperpigmentation changes along the previous whitish patches in the peripheral retina.

This case underscores the delayed onset of ocular ischemic symptoms associated with ICAD following head and neck trauma in young individuals. Despite the low risk, patients may need to be informed about the possibility of these late occurring ophthalmic complications and physicians need to stay vigilant for these conditions, which may arise months after the initial trauma.