Images in Clinical Medicine
Acute Optic-Nerve Infarction in Carotid Dissection
N Engl J Med 2010; 363:765August 19, 2010
- Article
A 33-year-old man presented to the emergency room after a massive object fell onto his head and neck. An acute epidural hematoma on the left side was identified and evacuated. On subsequent physical examination, the patient was stuporous and had flaccid hemiplegia on the right side and a dilated left pupil that was not responsive to light stimulation. Diffusion-weighted magnetic resonance imaging showed extensive infarctions of the left, middle, and bilateral anterior cerebral artery territories (Panel A). In addition, hyperintense lesions (Panel B) were observed in the bilateral optic nerves (arrowheads) and optic chiasm (arrow), findings that were consistent with acute ischemic infarction. Carotid angiography showed complete occlusion of the left internal carotid artery (Panel C, arrow). Given that the left optic nerve and part of the optic chiasm are typically perfused by small branches of the left internal carotid artery and anterior cerebral artery, infarction was probably caused by occlusion of the left internal carotid artery secondary to traumatic dissection. Contralateral optic-nerve infarction was probably caused by the occlusion of the right anterior cerebral artery as a result of subfalcine herniation, which is frequently observed in cases of large hemispheric infarction. Despite prompt evacuation of the epidural hematoma, the left hemispheric stroke rapidly progressed to fatal brain-stem herniation on the third day of hospitalization.
Sang-Bae Ko, M.D.
Kiwon Lee, M.D.
Columbia University College of Physicians and Surgeons, New York, NY
kl2356@columbia.edu - Citing Articles (1)
Citing Articles
1
C. Cauquil, R. Souillard-Scemama, M. Labetoulle, D. Adams, D. Ducreux, C. Denier. (2012) Diffusion MRI and tensor tractography in ischemic optic neuropathy. Acta Neurologica Belgica
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