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Título

Acute Occlusion of Central Retinal Artery diagnosed by Transcranial Doppler (TCD): a case report

RESUMO

Case Presentation: 70-years old female, previously with pre-diabetes, systemic arterial hypertension, and hypothyroidism. Presented acute amaurosis in the right eye, being evaluated by an ophthalmologist, who hypothesized retina detachment. On the following day, she was admitted to our service, a tertiary hospital with an Emergency room and Neurology. In the admission, she presented NIHSS 0. Ophthalmoscopy demonstrated indirect evidence of cherry-red spot and applied retina. Brain Angiotomography was performed, which was normal. Transcranial Doppler (TCD) with transorbital window was performed, demonstrating Right Central Retinal Artery (R-CRA) with a residual pattern, detecting only isolated systolic peaks, findings compatible with occlusion of the central retinal artery (OCRA). It was initiated with secondary prophylaxis with acetylsalicylic acid 100mg per day and simvastatin 40 mg per day. Exams were performed to investigate the stroke etiology, resulting in the atherothrombotic etiology with atheromatosis in the carotid bulbs bilaterally, with stenosis of nearly 50%.
Discussion: The OCRA is a medical emergency that provokes sudden and painless amaurosis and it must be treated as “Retinian stroke”. TCD with transorbital window allows the rapid and reliable detection of several signs which suggest its presence and even the OCRA mechanism, such as the absence of flow in the CRA and the presence of hyperechoic material in the retrobulbar circulation of the optic nerve. TCD can detect signs of OCRA, including in cases with unremarkable initial ophthalmologic evaluation. It has been evidence high sensibility of this method, and due to this fact, it is an important tool to diagnose OCRA and investigate the stroke etiology, which could guide the clinical treatment.
Final considerations: TCD is a relevant diagnostic method in the suspect cases of OCRA, which can have no alterations in the angiotomography and ophthalmoscopy. The OCRA diagnosis is fundamental to establishing the acute treatment and definition of secondary prophylaxis. This exam was incorporated into our service in cases and made it possible for the confection of a specific protocol to attend OCRA cases.

Palavras Chave

Transcranial Doppler; Acute Occlusion; Central Retinal Artery; Amaurosis; Stroke