Internal carotid artery dissection manifesting as paracentral acute middle maculopathy: a case report and review of literature

Paracentral acute middle maculopathy (PAMM), which is a microvasculopathy characterized by ischemic injury to the middle retinal layers, typically presents with acute-onset paracentral scotomas, PAMM is often monocular, and may lead to permanent visual field defects. In this case report, we present a patient with acute paracentral acute middle maculopathy (PAMM) due to internal carotid artery dissection (ICAD), without any other systemic symptoms. A 37-year-old male presented with acute visual impairment in his left eye. Cerebral angiography confirmed ICAD. His visual acuity and function significantly improved following internal carotid artery angioplasty and thrombectomy. This case underscores the need for ophthalmologists to maintain heightened awareness of potential carotid pathology in patients presenting with PAMM. Concurrently, neurologists should closely monitor retinal perfusion status in patients with ICAD. Multidisciplinary collaboration and precision medicine strategies are pivotal for optimizing patient outcomes.