PMC10114027_01
CTA head and neck with contrast. Left internal and external carotid occlusion. Vessel cutoff notated with arrow.
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F1
Computerized tomography angiography of the head and neck showed an occlusion of the entire left cervical internal carotid artery and occlusion of the origin of the left external carotid artery (Fig. 1).
MRI diffusion-weighted imaging showing left cerebellar ischemic stroke in the posterior inferior cerebellar artery territory.
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F2
Ten days later, the patient presented with right peripheral vision loss and was found to have a new left posterior cerebral artery/posterior inferior cerebellar artery stroke (Fig. 2).
MRI diffusion-weighted image with high cortical left ACA/MCA watershed infarction.
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F3
Seventeen days later, she again presented to the hospital with nausea and vertigo and was found to have a subacute infarction in the left parietal lobe corresponding to left anterior communicating artery/middle cerebral artery watershed territory (Fig. 3).
a Multicolor fundus photography of the right eye. b Fundus autofluorescence of the right eye. c Multicolor fundus photography of the left eye 1 month after the first presentation shows optic nerve atrophy, impressive arterial narrowing, atrophic retina, and extensive retinal pigment epithelium (RPE) and choroid changes, especially inferiorly. d Fundus autofluorescence of the left eye 1 month after the first presentation depicts extensive hypo- and hyper-autofluorescence changes 1 month after the first presentation. e Optical coherence tomography image of the left eye shows diffused thinning of both inner and outer retinal layers. Fluorescein angiography and ICGA of the left eye 1 month after the first presentation show impressive arterial narrowing with retina hypoperfusion (f) and hypoperfusion of choroid (g). ICGA, indocyanine green angiography.
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F4
Fundus fluorescein angiography, indocyanine green angiography (ICGA), and macular optical coherence tomography were obtained and confirmed central retinal artery and ophthalmic artery occlusion with atrophic retina (Fig. 4).