PMC5298438_01
Composite demonstrating partial occlusion of a branch retinal arteriole characterised by embolic material within the retinal arteriole and 'cotton wool spots' of the adjacent retina. Spectralis Multicolor  images comprising multicolour and associated infrared reflectance, green reflectance, blue reflectance images at time of presentation (a) and at six months later (b) with associated retinal thickness heat maps (c) and absolute thickness measurements in microns (d) at the same time points; change in retinal thickness is also shown (e).
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PMC5298438_01_10.1177_2054270416669302-fig1.jpg
fig1-2054270416669302
These findings were also visualised with optical coherence tomography - Figure 1.
Fundus fluorescein angiogram demonstrating reduced flow through a branch macular arteriole arising from the inferotemporal arcade visualised with 55' lens (a) and ultra-widefield lens (b) of the Heidelberg Spectralis HRA OCT. The cotton wool spots are seen as three hypofluorescent areas.
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PMC5298438_01_10.1177_2054270416669302-fig2.jpg
fig2-2054270416669302
Holter monitoring test showed sinus rhythm throughout, and conventional transthoracic echocardiography was insignificant. However, a transthoracic echocardiographic bubble contrast study, which showed no evidence of bubbles transiting at rest, did show a large right to left shunt at the atrial level within one beat of release of valsalva manoeuvre - Figure 2.