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Acute monocular visual loss: time to call the stroke team?
  1. Jacob Day1,
  2. Housam Monla-Haidar2,
  3. Vasant Raman3,
  4. Stuart Weatherby4
  1. 1 Neurology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
  2. 2 Ophthalmology, Musgrove Park Hospital, Taunton, UK
  3. 3 Ophthalmology, University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK
  4. 4 Neurology, University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK
  1. Correspondence to Dr Jacob Day; jacobday{at}doctors.org.uk

Abstract

A man in his 90s presented with acute monocular loss of vision; the emergency department triage alerted the stroke team. He underwent urgent parallel assessments by the stroke and ophthalmology teams and was diagnosed with central retinal artery occlusion. The ultimate decision was made to manage him conservatively, rather than with intravenous thrombolysis, and his visual function has remained poor. We discuss the current evidence for using intravenous thrombolysis in people with central retinal artery occlusion and use this case to exemplify the practical issues that must be overcome if ongoing randomised clinical trials of central retinal artery occlusion confirm a definite benefit from using intravenous thrombolysis.

  • STROKE
  • CLINICAL NEUROLOGY
  • FIBRINOLYSIS
  • VISION

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Footnotes

  • X @DrJacobDay

  • Contributors JD, HM-H and SW reviewed the patient during admission. SW conceived and critically reviewed the article. JD wrote the first draft of the article. HM-H provided annotated retinal photographs and critically reviewed the article. VR critically reviewed the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Luke Bennetto, Bristol, UK and Susan Mollan, Birmingham, UK.

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