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Color fundus photo of the left eye demonstrating left superior hemiretinal artery occlusion
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Figure 0001: Color fundus photo of the left eye demonstrating left superior hemiretinal artery occlusion

Mentions: He was not on any prophylactic treatment for migraine and the last episode was one month prior to presentation. On examination visual acuity was 20/20 bilaterally; he had a left relative afferent pupillary defect and a left inferior altitudinal visual field defect. The right visual field was normal. Left eye fundus examination revealed superior hemiretinal artery occlusion [Fig. 1]. Right eye fundus showed area of dynamic spasm along the superior temporal branch retinal artery, the arteriolar spastic cycle was about 2 sec in duration [Fig. 2a–c]. Timing of the vasospastic cycle was performed at a slit-lamp and photographs were subsequently taken to represent different phases of the cycle.

Dynamic focal retinal arteriolar vasospasm in migraine

Abdul-Rahman AM, Gilhotra JS, Selva D - Indian J Ophthalmol (2011 Jan-Feb)

Bottom Line: He was given acetazolamide 500 mg orally, timolol maleate 0.5% eye drops once daily and sublingual amyl-nitrate 0.8 mg, and maintained on felodipine 10 mg/day and aspirin 100 mg/day.The area of focal arteriolar spasm in the right eye resolved over two months.To our knowledge there are no prior reports of photographically documented dynamic focal retinal vascular spasm on a MEDLINE and PUBMED search.

Affiliation: Department of Ophthalmology, Manukau SuperClinic, Auckland 6, New Zealand. anmar_rahman@hotmail.com

ABSTRACT
A 48-year-old man presented following an episode of sudden onset simultaneous inferior altitudinal visual loss in his left eye and visual obscuration with shimmering in the inferonasal quadrant of the right eye. Clinical examination demonstrated left superior hemiretinal artery occlusion and an area of focal dynamic spasm along the right superior temporal branch retinal artery, the arteriolar spastic cycle was about 2 sec in duration. Hematological (including complete blood count, thrombophilia screen, vasculitic screen and serum magnesium), carotid, and cardiac investigations were normal. He was given acetazolamide 500 mg orally, timolol maleate 0.5% eye drops once daily and sublingual amyl-nitrate 0.8 mg, and maintained on felodipine 10 mg/day and aspirin 100 mg/day. The area of focal arteriolar spasm in the right eye resolved over two months. To our knowledge there are no prior reports of photographically documented dynamic focal retinal vascular spasm on a MEDLINE and PUBMED search.

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