Neuro-Ophthalmic Vascular Disease

This 32-year-old woman was referred with a history of 4 days of loss of vision OD. She had a history of manic depressive illness and IV drug abuse; she had been HIV tested 4 weeks before and was negative. She said she last injected cocaine 5 days before being seen, the night before she awoke with the visual loss. She passed out and awoke blind in the right eye. She said that she had fallen asleep on the edge of her kitchen sink, with her right eye down. There was no other ocular history, and she thought that her vision was slightly better now. Her examination showed acuities of HM OD, 20/30 OS, with Ishihara plates 0/10 OD, 10/10 OS. The pupils were 4/4, sluggish OD, with a +3 APD OD. There was a 3 mm of proptosis OD with normal retropulsion. The motility showed 2+ underaction (UA) RMR, RLR OD, 4+ UA upgaze, trace UA downgaze; the OS was normal. There was no restriction on forced duction. The rest of the cranial nerves were normal. The slit-lamp examination was normal (she never had a red, chemotic eye), and no bruits were audible. The fundus was normal OS, the right eye showed the residua of a cherry-red spot, with pallid edema in the maculopapillar bundle; the disc and retina were perfused. The MRI was normal, the ERG was flat OD, indicating ophthalmic artery occlusion, and the diagnosis is Saturday night retinopathy and ophthalmoplegia. Note the development of the retinal pigmentation over time, indicating that the ophthalmic artery was involved. Pair with 93_54, 93_55, 93_57, 93_58, 93_59, 93_60, 93_61, 93_62, 93_63, and 93_64.curriculum_fello