Ophthalmic and retinal artery occlusion associated with caudate nucleus infarction in an adolescent: a case report

INTRODUCTION: Both ophthalmic and retinal artery occlusion and caudate nucleus infarction are forms of arterial ischemic stroke, which are rare in adolescents. The causal relationship between these two events is still unclear. CASE PRESENTATION: A 17-year-old Han Chinese boy presented with vision loss in his left eye for 24 h and was diagnosed with ophthalmic and retinal artery occlusion. The ophthalmologic examination showed no light perception and no pupil light reflex. The fundus examination revealed a cherry-red spot at the macula with white ischemic retina and optic disc. Intra-arterial thrombolysis (urokinase 100,000 units and papaverine 30 mg) was performed 24 h after symptom onset. On the second day postoperatively, the patient complained of headache and dizziness, and magnetic resonance imaging of the brain revealed subacute caudate nucleus infarction. Etiological workup including cardiac, coagulation, autoimmune, and inflammatory tests was negative except for borderline elevated cholesterol and positive CMV IgG with no evidence of active infection. Despite continuous treatment, the vision in his left eye remained sense light 2 months after he was discharged. CONCLUSION: Ophthalmic and retinal artery occlusion is an ophthalmologic emergency and deserves more aggressive treatment in adolescents. Caudate nucleus infarction is also an emergency that impairs health. In this adolescent case, the concurrent occurrence of these two events was rare, but the causal relationship remains unproven. Further etiological clarification is needed. More attention should be paid to the general condition of adolescents, and provide comprehensive assessments, treatment, and follow-ups.