Paracentral acute middle maculopathy following internal carotid artery stenting due to carotid artery dissection: a case report

Abstract

Carotid artery dissection (CAD) is an important cause of cerebral and retinal ischemia especially in young adults. We present a case of paracentral acute middle maculopathy (PAMM) following internal carotid artery stenting (ICAS) in the setting of CAD. A 41-year-old female patient underwent ICAS procedure with the diagnosis of internal CAD after she complained of ptosis in her left eye (OS), blurred vision, numbness in the tongue and headache on the left side two weeks ago. After ICAS, she complained of blackness in the visual field in his left eye, describing a paracentral scotoma. Fundus examination of OS showed four whitish yellow subtle intraretinal lesions superonasal to fovea and along the vascular arcades. Fundus autofluorescence showed two hypofluorescent lesions, spectral domain optical coherence tomography showed hyper-reflective band in the inner and middle retina layers, fundus fluorescein angiography depicted hypofluorescent lesions, optical coherence tomography angiography demonstrated flow deficits in superficial capillary plexus and deep retina capillary plexus consistent with lesion areas in OS. All investigations and ophthalmological examination of her right eye were normal. Based on the history and findings, she was diagnosed with PAMM. Our case underscores the importance to recognize retinal complications in the setting of carotid dissection and its related interventional procedures.