ABSTRACT

A 76-year-old lady presented to emergency department for left eye sudden visual loss, and fundoscopy found cherry-red spot over the central macula with attenuated retinal vessels. Central retinal artery occlusion (CRAO) was diagnosed. She did not complain of new onset headache, but mild tenderness on palpation over left temporal area with vaguely weak pulsation detected. After the acute management of CRAO pharmacologically, rebreathing into paper bag, and ocular massage; patient underwent hyperbaric oxygen therapy hoping to salvage the ischemic retina while waiting for the erythrocyte sedimentation rate result. Result was >100 mm/hr, and high dose oral steroid was started immediately. Superficial temporal artery biopsy (TAB), performed 2 days after steroid treatment, was diagnostic of giant cell arteritis (GCA). Positron emission tomography and computerized tomography scan revealed vasculitis over thoracic aorta, left common carotid and subclavian artery. Ocular imaging of CRAO, histology of GCA on TAB are discussed with the interesting images.

References

1Gong H, Song Q, Wang L. Manifestations of central retinal artery occlusion revealed by fundus fluorescein angiography are associated with the degree of visual loss. Exp Ther Med 2016;11:2420-4.

2Mehta N, Marco RD, Goldhardt R, Modi Y. Central Retinal Artery Occlusion: Acute Management and Treatment. Curr Ophthalmol Rep 2017;5:149-59.

3Winkler A, True D. Giant Cell Arteritis: 2018 Review. Mo Med 2018;115:468-70.

4Olson EA, Lentz K. Central Retinal Artery Occlusion: A Literature Review and the Rationale for Hyperbaric Oxygen Therapy. Mo Med 2016;113:53-7.

5Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990;33:1122-8.

6Wang AL, Raven ML, Surapaneni K, Albert DM. Studies on the Histopathology of Temporal Arteritis. Ocul Oncol Pathol 2017;3:60-5.

7Poller DN, van Wyk Q, Jeffrey MJ. The importance of skip lesions in temporal arteritis J Clin Pathol 2000;53:137-9.

8Foss F, Brown L. An elastic Van Gieson stain is unnecessary for the histological diagnosis of giant cell temporal arteritis. J Clin Pathol 2010;63:1077-9.