First Author: M.Coban Karatas TURKEY
Co Author(s): M. Soylu
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To present a case with visual deterioration in the right eye with numbness, pain and tingling sensation in both lower legs.
A case report
A 53-year-old woman complained of visual deterioration in the right eye. Her anamnesis revealed no ocular and systemic diseases except a flu-like disease with mild symptoms a week ago. Her best corrected visual acuity (BCVA) was 0.5 in the right eye and 1.0 in the left eye. Anterior segment examination and intraocular pressure was in normal range. Fundoscopic examination revealed splinter heamorrhages, optic nerve head heamorrhage and cotton wool spots due to ischaemia on superior arcuate region and diagnosed as branch retinal vein occlusion (BRVO). Fundus fluorescein angiography revealed no ischaemic areas, however there was hypofluoresence in the areas corresponding to haemorrhages and hyperfluoresence in the optic nerve head. Optical coherence tomography revealed macular edema and intraretinal edema and hypereflective spots at the nasal side of fovea corresponding to the areas affected by the occlusion. Laboratory and radiological work up is requested for aetiological diagnosis of BRVO. One week after these complaints she had numbness, pain and tingling sensation in both lower legs. As the motor weakness of both extremities became more aggravated over time she was admitted to the neurology clinic for advanced examination and treatment.
No abnormalities in the brain and spinal cord magnetic resonance imaging were detected. Complete blood count, electrolytes and blood chemistry and urinanalysis were normal. Erythrocyte sedimentation rate, anticardiolipin G and M were in normal range. Lumbar puncture revealed no pathology. She is diagnosed as Guillain-Barre Syndrome and treated with intravenous immunoglobulin and pulse methylprednisone. Her symptoms improved in the following 3 months. During her follow up BCVA returned to 1.0 in the right eye without any treatment for ocular findings.
There is a significant association of advancing age with BRVO, and the incidence increases with age. Our patient was relatively young and did not suffer from systemic diseases related to BRVO. In conclusion our case is presented to emphasize the importance of aetiological diagnosis in BRVO. BRVO may be an initial finding in Guillain-Barre syndrome which may lead to serious neurologic complications.