case_images: PMC9756760_01
case_images: Fundus photography did not show disc swelling in either eye (A,B) but mild atrophy in the right eye (A), and fluorescence angiography did not show optic disc leakage or vascular filling defect in both eyes (C,D). Optical coherence tomography (OCT) showed normal average retinal nerve fiber layer (RNFL) thickness in both eyes (E) but the thickness of the ganglion cell complex (GCC) layer in the right eye was decreased (F). OCT did not show a significant change in inner retinal layer thickness (G). Twenty-four-hour Holter monitor showed atrial fibrillation (AF) with rapid ventricular response at a rate of 173 beats per minute (H). Photomicrograph of a temporal artery showed mild intimal thickening, otherwise nonspecific (I). ONH, optic nerve head.
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case_images: F1
case_images: Bilateral fundus did not show optic disc edema or hemorrhage in either eye but mild atrophy in the right eye (Figures 1A,B). In addition, fluorescence angiography did not reveal leakages or filling defects but showed mild hypofluorescence in the right eye (Figures 1C,D). Optical coherence tomography (OCT) showed normal average retinal nerve fiber layer (RNFL) thickness in both eyes (Figure 1E) but the thickness of the ganglion cell complex (GCC) layer in the right eye was decreased (Figure 1F). OCT did not show a significant change in inner retinal layer thickness (Figure 1G). Electrocardiogram (ECG) showed AF with rapid ventricular response, and the 24-h Holter monitor showed AF with rapid ventricular response at a rate of 173 beats per min (Figure 1H). Histologically, the temporal artery showed intimal thickening but no evidence of arteritis (Figure 1I).
case_images: Diffusion-weighted magnetic resonance imaging (MRI) of the brain revealed diffusion restriction in the posterior area of both optic nerves (A) which corresponded with the hypo-intensity in the apparent diffusion coefficient (ADC) map (B). Contrast-enhanced axial T1-weighted images revealed enhancement of the bilateral optic nerves in the posterior segment (C,D). Diffusion-weighted MRI of the brain showed multiple scattered lesions of high signal intensity involving bilateral periventricular white matter corresponding to acute embolic stroke (E-G).
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case_images: F2
case_images: Diffusion-weighted magnetic resonance imaging (DWI) of the brain showed diffusion restriction in multiple scattered areas involving bilateral periventricular white matter corresponding to acute embolic stroke (Figures 2E-G) and in the posterior area of both optic nerves (Figure 2A), which also corresponded with the hypointensity in the apparent diffusion coefficient (ADC) map (Figure 2B). Contrast-enhanced axial T1-weighted images revealed enhancement of optic nerves (Figures 2C,D).
case_images: Follow-up fundus photography showed pale and atrophic disc in both eye (A,B), and cptical coherence tomography (OCT) retinal nerve fiber layer (RNFL) analysis showed normal RNFL thickness in the left eye but RNFL thinning in the right eye (C). The thickness of the ganglion cell complex (GCC) demonstrated severe thinning in both eyes (D).
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case_images: F3
case_images: Bilateral fundus showed pale and mild atrophic optic disks (Figures 3A,B). Follow-up OCT showed normal average RNFL thickness in left eye but RNFL thinning in the right eye (Figure 3C), and the thickness of the GCC layer was decreased in both eyes (Figure 3D).