London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 399 216 Vascular imaging COLOR DOPPLER IMAGING FINDINGS IN CENTRAL RETINAL ARTERY OBSTRUC-TION D.C. Jianu1, S.N. Jianu2, D.F. Muresanu3 University of Medicine and Pharmacy “Victor Babes”, ”E.Murgu” Square, no. 2, First Dept of Neurology, County Emergency Hospital, “I. Bulbuca” street, Timisoara, ROMANIA1, Military Emergency Hospital Department of Ophthalmology, Timisoara, ROMANIA2, University of Medi-cine and Pharmacy “Iuliu Hatieganu” Department of Neurology, Cluj-Napoca, ROMANIA3 Introduction. Central Retinal Artery Obstruction (CRAO) represents an abrupt diminution of blood flow through the CRA severe enough to cause ischemia of the inner retina and permanent unilateral visual loss. Therefore, it is very important to identify the cause, in order to protect the other eye. Purpose. To assess the role of Color Doppler Imaging (CDI) of orbital vessels and Extracranial Du-plex sonography in the etiological diagnosis of CRAO. Patients and methods. Three patients with clinical suspicion of unilateral right CRAO were exam-ined following a complex protocol including CDI of orbital vessels. Results. They had no emboli visible on ophthalmoscopy. The first patient had no blood flow signal on CDI on a surface of 4 millimeters behind the right optic disc. B-scan ultrasound (US) evaluation found a small round, moderate reflective echo within the right optic nerve, 2 millimeters behind the optic disc. Right internal carotid arteries (ICA) US examination found an ulcerated ateromatous plaque, as being the source of cholesterol emboli. The second patient had very low blood flow ve-locities in the right CRA, due to an acute right ICA occlusion.The third patient had characteristic CDI findings for Horton disease: low blood velocities, especially end-diastolic velocities, and high RI in all retrobulbar vessels, in both orbits. Conclusions. Ultrasound investigation enables prompt differentiation between CRAO of embolic mechanism and CRAO caused by vasculitis from GCA. The second group should be quickly treat-ed with corticosteroids in order to protect the fellow eye from going blind. 217 Vascular imaging Giant cell arteritis as a cause of vertebrobasilar territory TIAs in an elderly patient R. Geraldes1, C. Silva2, A.P. Pita-Lobo3, M.F. Soares4, A. Palha5 Stroke Unit, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTUGAL1, Stroke Unit, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTUGAL2, Stroke Unit, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTUGAL3, Cerebral Hemo-dinamics Laboratory, Department of Neurosciences, Santa Maria Hospital, Lisbon, PORTUGAL4, Pathology Department, Santa Maria Hospital, Lisbon, PORTUGAL5 Background: Giant cell arteritis (GCA) is a rare cause of stroke. The cumulative incidence of Tran-sient Isquemic Attacks / ischemic stroke in GCA series is about 3-7%, occurring more frequently in the vertebrobasilar territory. Case Report: A 74 year-old man, with atrial fibrillation (AF) and dyslipidemia on clopidogrel and amiodarone, is admitted to our Stroke Unit due to paroxysmal episodes of vertigo lasting few min-utes followed, 5 days later, by an 6-hour episode of dysarthria and left hemiparesis. The patient mentioned weight loss of about 20 kg in about 3 months, associated with malaise, myalgias, bilater-al temporal headache that got worse with local pressure, jaw claudication and dysphagia. Brain with angio MRI showed non recent left cerebellar and thalamic ischemic lesions, moderate leucoaraiosis and no flow signal in the vertebral arteries, basilar trunk and posterior cerebral arteries. Cervical vessels ultrassonography showed vertebral artery stenosis associated with hypoechoic image along the vessel wall, suggestive of an inflammatory halo. This halo was also observed at the superficial temporal artery (STA) by Collor EcoDoppler. Erytrocyte sedimentation rate (ESR) was 74mm/ hr. The ECG showed atrial fibrillation. Pathological examination of the right STA corroborated the diagnosis of GCA. High dose steroid therapy was started with clear clinical improvement and nor-malization of ESR. Signs of ocular vasculitis were excluded by Ophthalmologic evaluation. Though initially on aspirin the patient was discharged on oral anticoagulation due to AF. Conclusion: In elderly patients with vertebrobasilar ischemic stroke, even with other documented possible etiologies, in presence of systemic complaints, headache and / or increased inflammatory parameters the diagnosis of GCA should be considered. Cervical vessels and STA EcoDoppler seem to be very useful in this context.
Karger_ESC London_2013
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