Authors: Nesrine Abroug, Safa Ben Aoun, Imen Ksiaa, Marouane Lahdhiri, Bechir Jelliti, Moncef Khairallah

Affiliation: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia

Clinical presentation: A 42-year-old healthy patient presented with sudden headache with transient visual loss followed by persistent central scotoma of the right eye (RE). On examination, the visual acuity was 20/25 in the RE and 20/20 in the LE. Results of slit-lamp examination were unremarkable. Fundus examination showed whitening of the posterior pole with cherry red spot.

Imaging findings: Fluorescein angiography showed delayed choroidal and retinal perfusion. Swept source OCT revealed a band-like hypereflective lesion at the level of the inner nuclear layer consistent with the diagnosis of paracentral acute middle maculopathy (PAMM). Swept source OCTA showed severe attenuation of the deep capillary plexus. Computed tomographic and magnetic resonance angiography scans revealed right internal carotid artery occlusion. The patient was diagnosed with internal carotid artery dissection and treated with antithrombotic drugs.

Discussion points: Swept source imaging is useful in the diagnosis and monitoring of PAMM. Carotid artery dissection should be considered in the differential diagnosis of PAMM.

Financial disclosure: No