case_images: PMC5641998_01
case_images: Brain magnetic resonance imaging (MRI). a Sagittal FLAIR-weighted sequence demonstrated diffuse hyperintense signal in the corpus callosum, b axial T1-weighted sequence showed multiple periventricular black holes, c, d axial FLAIR-weighted and coronal T2-weighted sequences showed periventricular lesions, e, f axial FLAIR-weighted and axial T2-weighted sequences demonstrated small lesions with hyperintense signal in the internal capsule
case_images: 40942_2017_92_Fig1_HTML.jpg
case_images: PMC5641998_01_40942_2017_92_Fig1_HTML.jpg
case_images: Fig1
case_images: Brain MRI demonstrated hyperintense signal in the corpus callosum and multiple periventricular black holes which are respectively consistent with corpus callosum thinning and periventricular white mass microinfarctions (Fig. 1). 
case_images: a1, b1, c1, d1, e1 Color fundus photograph (a1) of the right eye showed a superior temporal arteriolar narrowing within macular area. Fluorescein angiography (FA) (b1) depicted a branch retinal arterial occlusion (BRAO) in the superior temporal macula of the right eye. Optical coherence tomography angiography (OCTA) perfusion map 6 x 6 mm of superficial and deep capillary plexuses (c1, d1) of the right eye revealed temporal parafoveal hypoperfusion. B-scan OCT (e1) of the right eye showed thinning of the inner retina temporal to the fovea, f1, g1, h1, i1, j1 color fundus photograph (f1) of the left eye showed no abnormalities within the macula area. FA (g1) demonstrated non-perfusion associated with leakage in the temporal periphery of the left eye. OCTA perfusion map 6 x 6 mm of superficial and deep capillary plexuses (h1, i1) of the left eye revealed small spots of decreased vascular perfusion within the macular area. Thinning of the inner retina temporal to the fovea was also observed on B-scan OCT in the left eye (j1), a2, b2, c2, d2, e2 at 6-month follow-up, although color fundus photograph (a2) of the right eye did not reveal any change in comparison with the baseline exam, the signs of BRAO disappeared on FA (b2). OCTA perfusion map 6 x 6 mm of superficial and deep capillary plexuses (c2, d2) of the right eye showed an impressive improvement of vascular perfusion in the previous baseline hypoperfused areas, e2 thinning of the inner retina temporal to the fovea of the right eye remained at 6-month follow-up, f2, g2, h2, i2, j2 at 6-month follow-up, the color fundus photograph (f2) of the left eye did not reveal any change in comparison with the baseline exam, and the FA (g2) revealed new vascular staining on the temporal superior vascular arcade (arrow) and maintenance of peripheral vascular leakage. OCTA perfusion map 6 x 6 mm of superficial and deep capillary plexuses (h2, i2) of the left eye showed improvement of previous small hypoperfused areas, j2 thinning of the inner retina temporal to the fovea of the left eye remained at 6-month follow-up
case_images: 40942_2017_92_Fig2_HTML.jpg
case_images: PMC5641998_01_40942_2017_92_Fig2_HTML.jpg
case_images: Fig2
case_images: Color fundus photograph (TRC50DX, Topcon, Japan) of the right eye revealed a superior temporal arteriolar narrowing within macular area and was unremarkable in the left eye (Fig. 2a1, f3). BRAO in the superior temporal macula of the right eye and vascular leakage in the temporal peripheral retina of the left eye (Fig. 2b1, g3). B-Scan OCT (Spectral-domain OCT Spectralis, Heidelberg Engineering, Germany and DRI Swept Source OCT Triton, Topcon, Japan) demonstrated inner retinal thinning on the temporal side of the macula in both eyes (Fig. 2e1, j3). This temporal retinal thinning was more pronounced in the right eye. Although fundus color photograph (Fig. 2a2, f4) did not reveal any change in comparison with the baseline fundus exam (Fig. 2a1, f3), a vascular leakage was observed in the retinal periphery of the left eye (Fig. 2b2, g4). At 6-month follow up visit, it was 47.67% in superficial and 50.7% in the superficial and deep capillary plexuses, respectively. (Fig. 2c2-d2, h4-i4).
case_images: a Visual field test (24-2 strategy) of the right eye revealed nasal, central and paracentral temporal sensitivity loss, b visual field test (24-2 strategy) of the left eye showed visual field loss in the nasal periphery, sparing the central vision, c, e microperimetry of the right eye showed a large area of low sensitivity in the temporal macula that corresponded to the same topography of decreased vascular perfusion on OCTA 9 x 9 mm composite image of the superficial capillary plexus perfusion map, d, f microperimetry of the left eye showed a very small area of low sensitivity temporally to the macula that corresponded to the same topography of decreased vascular perfusion on OCTA 9 x 9 mm composite image of the superficial capillary plexus perfusion map
case_images: 40942_2017_92_Fig3_HTML.jpg
case_images: PMC5641998_01_40942_2017_92_Fig3_HTML.jpg
case_images: Fig3
case_images: Color fundus photograph (TRC50DX, Topcon, Japan) of the right eye revealed a superior temporal arteriolar narrowing within macular area and was unremarkable in the left eye (Fig. 2a1, f3). BRAO in the superior temporal macula of the right eye and vascular leakage in the temporal peripheral retina of the left eye (Fig. 2b1, g3). B-Scan OCT (Spectral-domain OCT Spectralis, Heidelberg Engineering, Germany and DRI Swept Source OCT Triton, Topcon, Japan) demonstrated inner retinal thinning on the temporal side of the macula in both eyes (Fig. 2e1, j3). This temporal retinal thinning was more pronounced in the right eye. Topcon, Japan) revealed vascular hypoperfusion within the macular area in both superficial and deep capillary retinal plexuses (Fig. 2c1-d1, h3-i3). The area of OCTA vascular hypoperfusion corresponded to the topography of BRAO seen on FA in the right eye. The OCTA segmentations in the outer retina and choriocapillaris were unremarkable in both eyes.  Technologies, Italy) showed visual function loss in both eyes (Fig. 3a-d). VF demonstrated nasal, central and paracentral decreased sensitivity in the right eye, and solely peripheral nasal decreased sensitivity in the left eye. MP depicted decreased sensitivity in the upper, inferior and temporal macula in the right eye, and decreased sensitivity in the temporal macula in the left eye. These low VF and MP sensitivity signals corresponded to the decreased vascular perfusion seen on the OCTA density map (Fig. 3e, f).  At 6-month follow up visit, it was 47.67% in superficial and 50.7% in the superficial and deep capillary plexuses, respectively. (Fig. 2c2-d2, h4-i4).