The role of MRI in ophthalmic arteritis

Abstract

CASE FINDINGS: A 53-year-old gentleman with a history of heavy smoking and uncontrolled hypertension presented with the third, longest, and worst episode of right-sided headache and visual disturbance lasting several hours. Symptoms started 2 days before, and previous episodes lasted 15 to 30 minutes. Positive findings on initial examination were revealed blood pressure of 147/112 mm Hg, right visual acuity less than Snellen 3/60, but could count fingers, and very small refractile emboli in an arteriolar twig in the inferonasal macular area. Initial bloods included normal platelet count, C-reactive protein level of 38 mg/L (0–5 mg/L), and erythrocyte sedimentation rate of 27 mm/h (10–14 mm/h). The following day, his visual acuity had improved to Snellen 6/18 + 2. The retinal emboli were dislodged and no longer apparent. Fundus fluorescein angiography was consistent with right ophthalmic arterial insufficiency (Figs. 1A–D). The initial impression was of a nonarteritic retinal arteriolar embolic occlusion. Aspirin 75 mg by mouth was initiated. [excerpt]