Central retinal artery occlusion fromStreptococcus gallolyticusendocarditis

Abstract

Central retinal artery occlusion (CRAO) is a rare but blinding disorder. We present a case of a 81-year-old woman with multiple cardiovascular comorbidities admitted to the emergency department due to sudden, painless vision loss on left eye (oculus sinister (OS)) on awakening. The patient also reported long standing fatigue associated with effort that started 4 months before admission. She presented best corrected visual acuity of counting fingers OS. Funduscopy OS revealed macular oedema with cherry red spot pattern. Blood cultures came positive for Streptococcus gallolyticus in the context of a bacteremia and native mitral valve vegetation identified on transoesophageal echocardiography. CRAO of embolic origin was admitted in the context of an infective endocarditis. CRAO can be the first manifestation of a potentially fatal systemic condition and thus multidisciplinary approach is warranted with close collaboration between ophthalmologists and internists in order to provide proper management and the best possible treatment.

Central Retinal Artery Occlusion with Concomitant Intracranial Hemorrhage Secondary to Streptococcus Gordonii Endocarditis

“…However, it was ultimately in conjunction with the neurosurgery, neurology, and infectious disease consult services that diagnostics were widened to rule out septic emboli and occult malignancy. As emphasized by Serras-Pereira et al, such cases demonstrate the importance of multidisciplinary collaboration [ 2 ]. In summary, CRAO in an atypical patient should raise suspicion for endocarditis (particularly from opportunistic oral flora), with consideration given to early TEE imaging.…”

“…Central retinal artery occlusion (CRAO) is a severe ocular complication leading to irreversible vision loss [ 1 ]. Characterized by acute painless monocular vision loss, this condition presents with retinal whitening and a foveal cherry red spot [ 2 ]. In the acute stage, arteriolar “boxcarring” indicative of poor blood flow may be present.…”

“…CRAO secondary to endocarditis is a rarely reported phenomenon. This results from valvular vegetation embolizing into the systemic vasculature, with the causative microbes often unknown due to negative blood cultures at the time of diagnosis [2,[5][6][7]. Although uncommon, this represents a key mechanism to consider in cases of atypical CRAO given the potentially life-threatening sequelae.…”

The Gray Frosted Branch Sign in Central Retinal Artery Occlusion

“…Central retinal artery occlusion (CRAO) is a rare but blinding disorder characterized by an obstruction of retinal blood flow that may be due to an embolus, thrombus, vasculitis, traumatic vessel wall damage or spasm [2]. The gray frost-like changes around the arterioles in CRAO are different from Frosted branch angiitis (FBA).…”