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Vojnosanitetski pregled
2016, vol. 73, iss. 4, pp. 397-401
article language: English
document type: Case Report
published on: 06/04/2016
doi: 10.2298/vsp140814087C
Creative Commons License 4.0
Color Doppler imaging features in patients presenting central retinal artery occlusion with and without giant cell arteritis
aDepartment of Neurology, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
bDepartment of Oftolmology, Military Emergency Hospital, Timisoara, Romania
cDepartment of Ophthalmology, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
dDepartment of Pharmacology, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
eDepartment of Internal Medicine - Nephorology, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania



Introduction. Central retinal artery obstruction (CRAO) represents an abrupt diminution of blood flow through the CRA that is severe enough to cause ischemia of the inner retina with permanent unilateral visual loss. We presented the role of color Doppler imaging (CDI) of orbital vessels and of extracranial duplex sonography (EDS) in the etiological diagnosis of CRAO in two patients with clinical suspicion of unilateral CRAO. Case report. Patients were examined following the protocol which included CDI of orbital vessels and EDS. Both patients had no emboli visible on ophthalmoscopy. The B-scan ultrasound evaluation of the first patient found a small round, moderately reflective echo within the right optic nerve, 1.5 mm behind the optic disc (emboli of cholesterol). CDI of retrobulbar vessels revealed the normal right ophthalmic artery (OA) hemodynamic parameters, but the first patient had no arterial flow signal on CDI at the distance of 1.5 mm behind the right optic disc. In contrast, the left eye had the normal aspect on CDI of retrobulbar vessels. The right internal carotid artery EDS identified a severe stenosis at its origin as CRA's emboli source. The second patient had characteristic CDI findings for giant cell arteritis (GCA) with eye involvement: severe diminished blood flow velocities, especially end-diastolic velocities, in both CRAs. Less abnormalities were observed in the posterior ciliary arteries, and in the ophthalmic arteries. The second patient had no systemic symptoms or signs of GCA. Conclusion. In the presented cases, the ultrasound investigation enabled prompt differentiation between central retinal artery occlusion of embolic mechanism and CRAO caused by GCA.



Ahuja, R.M., Chaturvedi, S., Eliott, D., Joshi, N., Puklin, J.E., Abrams, G.W. (1999) Mechanisms of Retinal Arterial Occlusive Disease in African American and Caucasian Patients. Stroke, 30(8): 1506-1509
Arida, A., Kyprianou, M., Kanakis, M., Sfikakis, P.P. (2010) The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskeletal Disorders, 11(1)
Connolly, B.P., Krishnan, A., Shah, G.K., Whelan, J., Brown, G.C., Eagle, R.C., Shaking, E.P. (2000) Characteristics of patients presenting with central retinal artery occlusion with and without giant cell arteritis. Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 35(7): 379-384
Dragos, J., Silviana, J., Ligia, P., Mirce, S. (2011) Large Giant Cell Arteritis with Eye Involvement. in: Amezcua-Guerra LM [ed.] Advances in the Diagnosis and Treatment of Vasculitis, Rijeka: Intech
Duker, J.S. (2004) Retinal arterial obstruction. in: Yanoff M., Duker J.S., Augsburger J.J. [ed.] Ophtalmology, St. Louis, MO: Mosby, 2nd ed, p. 856-63
Foroozan, R., Savino, P.J., Sergott, R.C. (2002) Embolic central retinal artery occlusion detected by orbital color doppler imaging. Ophthalmology, 109(4): 744-747
Gonzalez-Gay, M.A. (2005) The diagnosis and management of patients with giant cell arteritis. Journal of rheumatology, 32(7): 1186-8
González-Gay, M.A., García-Porrúa, C., Llorca, J., Hajeer, A.H., Brañas, F., Dababneh, A., González-Louzao, C., Rodriguez-Gil, E., Rodríguez-Ledo, P., Ollier, W.E.R. (2000) Visual Manifestations of Giant Cell Arteritis: Trends and Clinical Spectrum in 161 Patients. Medicine, 79(5): 283-292
Hayreh, S.S. (2011) Vascular disorders in neuro-ophthalmology. Current Opinion in Neurology, 24(1): 6-11
Hayreh, S.S., Zimmerman, M.B. (2007) Fundus changes in central retinal artery occlusion. Retina, 27(3): 276-289
Jianu, D.C., Jianu, S.N. (2010) The role of color Doppler imaging in the study of central retinal artery obstruction. in: Jianu D.C., Jianu S.N. [ed.] Color Doppler Imaging: Neuro-ophthalmological correlations, Timisoara, Romania: Mirton, Chapter 6, p. 125-42. (Romanian)
Jianu, D.C., Jianu, S.N., Petrica, L. (2011) Color Doppler Imaging of retrobulbar vessels findings in large giant cell arteritis with eye involvement. J US-China Med Sci, 8(2); 99-108
Jianu, D.C., Jianu, S.N. (2013) Giant cell arteritis and arteritic anterior ischemic optic neuropathies. in: Sakkas L.I., Katsiari C. [ed.] Updates in the Diagnosis and Treatment of Vasculitis, Rijeka: Intech, Chapter 5, p. 111-30
Jianu, S.N., Jianu, D.C. (2011) Color Doppler imaging and central retinal artery occlusion. Oftalmologia, 55(4): 55-65
Lieb, W.E., Cohen, S.M., Merton, D.A., Shields, J.A., Mitchell, D.G., Goldberg, B.B. (1991) Color Doppler imaging of the eye and orbit. Technique and normal vascular anatomy. Archives of ophthalmology, 109(4): 527-31
Lopez-Diaz, M.J., Llorca, J., Gonzalez-Juanatey, C., Peña-Sagredo, J.L., Martin, J., Gonzalez-Gay, M.A. (2008) The Erythrocyte Sedimentation Rate Is Associated with the Development of Visual Complications in Biopsy-Proven Giant Cell Arteritis. Seminars in Arthritis and Rheumatism, 38(2): 116-123
Pichot, O., Gonzalvez, B., Franco, A., Mouillon, M. (1996) Color Doppler ultrasonography in the study of orbital and ocular vascular diseases. Journal français d'ophtalmologie, 19(1): 19-31
Rabinstein, A.A. (2014) Prolonged Cardiac Monitoring for Detection of Paroxysmal Atrial Fibrillation After Cerebral Ischemia. Stroke, 45(4): 1208-1214
Sacco, R.L., Toni, D., Brainin, M., Mohr, J.P. (2004) Classification of ischemic stroke. in: Mohr J.P., Choi D.W., Grotta J.C., Weir B., Wolf P.A. [ed.] Stroke: Pathophysiology, diagnosis and management, Philadelphia, PA: Elsevier Saunders, Chapter 4, 4th ed, p. 61-70
Schmidt, W.A., Kraft, H.E., Vorpahl, K., Völker, L., Gromnica-Ihle, E.J. (1997) Color Duplex Ultrasonography in the Diagnosis of Temporal Arteritis. New England Journal of Medicine, 337(19): 1336-1342