IJCNMH ARCpublishing

Issue: Issue 6 (2019) – Supplement 1


An off-road cause of right eye hypovision

Luís Lemos, Maria João Pinto, Andreia Teixeira, Daniela Ferro, Margarida Matias, Paulo Castro Chaves, Jorge Almeida, and Luísa Fonseca
Introduction: Despite being a rare cause of stroke, cervical artery dissection (CAD) is an important cause of stroke accounting for 20% of strokes in young patients. 
Case Report: A 46-year-old man, owner of a gymnasium, with no pathological history and no usual medication, except sporadic protein supplements, presented to the emergency department with suddenly blurred vision and hypovision of his right eye. He denied recent physical activity, headache, neck pain or trauma but he performed some off-road tracks the day before. On examination he was hemodynamically stable with lower left nasal quadrant of the right eye hypovision in monocular confrontation. Brain CT had no acute lesions. The angio-CT revealed a marked but gradual reduction of the endoluminal filling immediately after the carotid bulb, with complete absence of filling from the proximal half of the cervical segment of the artery to the communicating segment. He started antiplatelet therapy with favourably progression. On the third day after admission he performed cerebral MRI and angio-RM that confirmed dissection of the right internal carotid artery, from the post-bulbar region to the proximal cervical segment, with no flow signal and contrast filling upstream to the ophthalmic segment, and no visualization of the proximal portion of the right ophthalmic artery. It was not possible to identify the unequivocal cause for the carotid dissection. The only possible cause identified was the off-road tracks. At discharge he still had left nasal quadrant hypovision of the right eye. 
Conclusion: In this case stands out the severe and extensive carotid lesion whose only symptom was hypovision of the lower left nasal quadrant of the right eye, without parenchymal lesion on MRI.

From the Lisbon Stroke Summit, Lisbon, Portugal. 5–6 April 2019.

International Journal of Clinical Neurosciences and Mental Health 2019; 6(Suppl. 1):P26
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