case_images: PMC9868688_01
case_images: Color fundus photo (a) shows an embolus (black arrow) in the superior nasal artery associated to a pallor area distal to the embolus. Red free (b) easily exposes the embolus (black arrow) and the pallor area distal to the embolus. En face OCT (c) also shows the embolus (black arrow). OCTA (d-i), 3 weeks after the onset, shows that the vessel has decorrelation signal distal to the embolus, despite a dark area (red dotted triangle) in the outer retina (f) and choriocapillaris slabs (g). Perimetry (j) identifies total scotomas in the inferior temporal quadrant.
case_images: cop-2023-0014-0001-528142_f1.jpg
case_images: PMC9868688_01_cop-2023-0014-0001-528142_f1.jpg
case_images: F1
case_images: Color fundus photo (Fig. 1a) and red-free photo (Fig. 1b) in the right eye clearly showed an embolus in the superior nasal retinal arteriole associated with a pallor in the distal retina. En face OCT (Fig. 1c) also showed an artery embolus, and OCTA (done 3 weeks later) (Fig. 1d-i) has demonstrated the decorrelation signal in the superior nasal artery, indicating reperfusion. Perimetry (Fig. 1j) confirmed total scotomas in the inferior temporal visual field.
case_images: Transcranial Doppler with gaseous contrast medium shows the curtain pattern (high-grade shunt) even at rest (a) and after Valsalva maneuver (b). Presence of a cardiac right-to-left shunt is due to PFO with high paradoxical embolism risk.
case_images: cop-2023-0014-0001-528142_f2.jpg
case_images: PMC9868688_01_cop-2023-0014-0001-528142_f2.jpg
case_images: F2
case_images: A transcranial Doppler with contrast (Fig. 2) evidenced a severe number of microbubbles into the brain circulation even at rest and an increased quantity during the Valsalva maneuver, indicating the presence of an intracardiac right-to-left shunt and a higher risk of paradoxical embolism.