Subsequent acute ischemic stroke in a patient with monocular vision loss associated with isolated internal carotid artery occlusion: a case report

Abstract Background Despite a growing body of evidence and ongoing clinical trials assessing the efficacy of reperfusion therapies in the acute phase, reliable systems capable of rapidly identifying patients with central retinal artery occlusion (CRAO) and evidence-based therapeutic interventions that have been shown to improve visual outcomes, are currently lacking. In this report, we present an exceptional case involving CRAO with concurrent occlusion of the internal carotid artery (ICA), followed by an acute ischemic stroke (AIS) affecting the middle cerebral artery (MCA). Case presentation An 83-year-old woman with acute, painless vision loss in her right eye received intravenous thrombolysis (IVT) within 4.5 hours of admission, suspecting CRAO associated with ICA occlusion (ICAO) on CT angiography (CTA). One hour post thrombolysis, perfusion CT (CTP) confirmed MCA occlusion (MCAO), necessitating mechanical thrombectomy (MT). Endovascular intervention proceeded without complications, and the patient exhibited no functional impairments at discharge. Conclusions This case study underscores the significance of maintaining a vigilant approach toward stroke management in patients with CRAO. It highlights the diagnostic challenges encountered in clinical practice and advocates for further research regarding the role of IVT in CRAO patients due to ICAO, emphasizing the need for consensus in treatment.