Central retinal artery occlusion preceding hemispheric ischemic stroke treated with mechanical thrombectomy

Rationale: Central retinal artery occlusion (CRAO) is a form of ischemic stroke that may signal underlying cerebrovascular or cardiac disease. Patient concerns: A 52-year-old man developed sudden, painless vision loss in the right eye. Nine days later, he presented with left-sided weakness and speech difficulty, with a National Institutes of Health Stroke Scale (NIHSS) score of 8. His medical history included dilated cardiomyopathy, and electrocardiography revealed atrial fibrillation. Diagnoses: Ophthalmologic examination and fluorescein angiography supported right CRAO. Computed tomography (CT) angiography at neurological presentation showed right internal carotid artery occlusion from its origin. CT perfusion demonstrated estimated infarct core and penumbral volumes of 37 and 186 mL, respectively. Interventions: Emergency mechanical thrombectomy with aspiration and adjunctive balloon angioplasty achieved expanded Thrombolysis in Cerebral Infarction grade 2c reperfusion. Outcomes: The NIHSS score improved to 2 at discharge, 7 days after admission. At 3 months, the modified Rankin Scale score was 1, although right-eye visual loss persisted. Lessons: CRAO warrants prompt cerebrovascular and cardiac evaluation, with reassessment when new neurological deficits develop. The nine-day interval between retinal symptoms and thrombectomy does not establish the duration of carotid occlusion or cerebral ischemia. The favorable individual outcome does not establish the efficacy of thrombectomy beyond 24 hours.