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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.
Summary
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.