After a Stroke, Decreased Vision for a 73-Year-Old Patient

Rod Foroozan, MD


March 30, 2017


This patient developed decreased vision after a left middle cerebral artery stroke; however, the stroke was not the cause of the visual loss. The fact that the visual loss was monocular in the left eye suggested an alternative cause for the decreased vision.

Although an acute branch retinal arteriolar occlusion (BRAO) causes easily recognizable funduscopic findings in most patients, the diagnosis is more difficult when the retinal whitening resolves.

Certain clinical findings can be helpful in determining whether a visual deficit is from a previous BRAO. When BRAO causes visual loss, there are several distinct features, including:

  • A smaller RAPD

  • The frequent attenuation in caliber of the retinal arteriole in the involved distribution

  • The possibility of emboli in the distribution of the involved branch arteriole[1]

  • Atrophy of the involved RNFL often resulting in sectoral pallor of the corresponding portion of the optic disc

  • Possible sheathing of the involving retinal arteriole

OCT has helped visualize structural abnormalities of the retina and allowed for quantitation of retinal thickness. The inner one-half to two-thirds of the retina is primarily supplied by branches of the central retinal artery. Therefore, the occlusion of branches of the retinal arterioles would be expected to cause decreased thickness of not only the RNFL, but also of other inner retinal layers.[2,3] As a result, retinal artery occlusions cause a more profound thinning of the macula than ischemic optic neuropathy.[4]

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