Issue: Vojnosanit Pregl 2016; Vol. 73 (No. 4)

Color Doppler imaging features in patients presenting central retinal artery occlusion with and without giant cell arteritis

Authors:
Dragos Catalin Jianu, Silviana Nina Jianu, Mihnea Munteanu, Daliborca Vlad, Cosmin Rosca, Ligia Petrica

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Introduction. Central retinal artery obstruction (CRAO)
represents an abrupt diminution of blood flow through the
CRA that is severe enough to cause ischemia of the inner retina
with permanent unilateral visual loss. We presented the role of
color Doppler imaging (CDI) of orbital vessels and of
extracranial duplex sonography (EDS) in the etiological
diagnosis of CRAO in two patients with clinical suspicion of
unilateral CRAO. Case report. Patients were examined
following the protocol which included CDI of orbital vessels
and EDS. Both patients had no emboli visible on
ophthalmoscopy. The B-scan ultrasound evaluation of the first
patient found a small round, moderately reflective echo within
the right optic nerve, 1.5 mm behind the optic disc (emboli of
cholesterol). CDI of retrobulbar vessels revealed the normal
right ophthalmic artery (OA) hemodynamic parameters, but
the first patient had no arterial flow signal on CDI at the
distance of 1.5 mm behind the right optic disc. In contrast, the
left eye had the normal aspect on CDI of retrobulbar vessels.
The right internal carotid artery EDS identified a severe
stenosis at its origin as CRA’s emboli source. The second
patient had characteristic CDI findings for giant cell arteritis
(GCA) with eye involvement: severe diminished blood flow
velocities, especially end-diastolic velocities, in both CRAs.
Less abnormalities were observed in the posterior ciliary
arteries, and in the ophthalmic arteries. The second patient had
no systemic symptoms or signs of GCA. Conclusion. In the
presented cases, the ultrasound investigation enabled prompt
differentiation between central retinal artery occlusion of embolic
mechanism and CRAO caused by GCA.