Neuro-Ophthalmology

Case 14

Patient Presentation: A 77-year-old male presented to the emergency room with new headaches for 2 months, followed by jaw claudication, transient diplopia and loss of vision OD. His visual loss and symptoms became more severe the next day. His vision was CF@ 3ft OD and 20/30 OS, with a right RAPD. CRP was 30 (normal < 11) and ESR was 54. He was admitted for suspected GCA. The patient was treated with IV methylprednisolone 1g daily x 3 days followed by Prednisone 60mg PO daily.

One week following initial presentation, the patient was seen for follow-up and consideration of a temporal artery biopsy. Dilated fundus photos and OD OCT macula are shown below.

Neuro-Ophthalmology 14-1.png
Neuro-Ophthalmology 14-2.png

Question: What is the diagnosis based on the patient fundus findings and OD OCT macula?

Question: What is a clinically proven treatment for CRAO?

Neuro-Ophthalmology 14-3.png

Question: What pathology is this horizontal 5-line raster overlaying?

Question: How can one differentiate a cotton wool spot on OCT to a hard exudate?

Learning Objectives:

1. To evaluate the stage of CRAO based on macula OCT imaging

2. To examine a cotton-wool spot on OCT