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Retinal ischemia in aortic arch atheromatous disease
J G Romano1, V L Babikian, C A Wijman
1Department of Neurology, University of Miami, School of Medicine, Florida, USA.
Insights
Aortic plaques can cause retinal ischemia when other sources are ruled out. Transesophageal echocardiography helps identify these aortic emboli in patients with Hollenhorst plaques.
Area of Science:
- Ophthalmology
- Cardiology
- Neurology
Background:
- Retinal ischemia commonly results from cardiac or carotid artery emboli.
- Cholesterol emboli from the carotid bifurcation are frequent causes.
- However, definitive embolic sources remain unidentified in many patients.
Observation:
- Two patients presented with retinal ischemia and emboli.
- These emboli were traced to atheromatous plaques in the aorta.
- Transesophageal echocardiography visualized the aortic plaques.
Findings:
- Cardiac, carotid, and intracranial embolic sources were excluded in these patients.
- Microembolic signals in the middle cerebral artery confirmed embolic events.
- Aortic arch atheromatous plaques were identified as the source of retinal emboli.
Implications:
- The aortic arch is a potential source of emboli causing retinal ischemia, especially in patients with Hollenhorst plaques.
- Transesophageal echocardiography is recommended when initial evaluations for cardiac or carotid lesions are negative.
- This diagnostic approach can improve the identification of embolic sources for retinal ischemia.
Abstract:
Retinal ischemia is often caused by emboli arising from the cardiac chambers or the common carotid artery bifurcation; the latter are often composed of cholesterol. However, in many patients no lesions are identified after evaluation of these sources of emboli. Two patients were observed who had retinal ischemia and emboli originating from aortic atheromatous plaques that were visualized by transesophageal echocardiography. Cardiac, carotid, and intracranial sources of emboli were excluded. The embolic nature of retinal ischemia was further corroborated by the presence of microembolic signals during transcranial Doppler insonation of the middle cerebral artery on the side ipsilateral to the symptomatic retina. In patients with Hollenhorst plaques the aortic arch can be a potential source of emboli. Transesophageal echocardiography should be considered in these patients when the initial evaluation does not identify a cardiac or carotid lesion.