Titel | Retinal vascular accident in first trimester of pregnancy |
Doel | To highlight the need for systemic evaluation in patients with branch retinal artery occlusion (BRAO). |
Methodes | We examined a 31-year-old, 8 weeks pregnant woman who presented at our department of Ophthalmology of the University Hospitals Leuven with complaints of a whitish spot in front of her left eye for 1 day. A thorough routine ophthalmic examination was performed and completed with autofluorescence and infrared imaging, OCT-cirrus, OCT-angiography and fluorescein angiography as well as elaborated neurologic and cardiovascular review. |
Resultaten | A fundoscopic exam revealed a whitish elevated zone involving the superonasal macula with a congruent hyper-reflective zone in the inner retinal layers on optical coherence tomography. Fluorescein angiography showed a branch retinal artery occlusion and OCT-angiography showed disruption of the deep capillary plexus consistent with the diagnosis of BRAO associated with paracentral acute middle maculopathy. The patient was admitted to the stroke unit and a series of tests were performed. Thrombophilia screening showed an initial low protein C, but a second sample could not confirm the deficiency. Carotid duplex showed no stenosis and a duplex sonography of the lower extremities showed no evidence for thrombosis, but a transesophageal echocardiogram showed a small patent foramen ovale with a spontaneous right-left shunt. Both acetylsalicylic acid 80mg/day and dalteparin sodium 5000IU/day were started and a closure of the PFO will be performed after completion of the pregnancy. |
Conclusie | It is important to perform profound neurologic and cardiovascular examination in patients with BRAO. Underlying causes should be identified and accordingly treated to prevent other ischemic events. |
Belangenverstrengeling | Nee |
Naam | STOCKMAN |
Initialen | AC |
Instituut | UZ LEUVEN |
Stad | LEUVEN |
Naam | JACOB |
Initialen | J |
Instituut | UZ LEUVEN |
Stad | LEUVEN |
Naam | LEYS |
Initialen | A |
Instituut | UZ LEUVEN |
Stad | LEUVEN |