(BMJ)—A 31-yo, 11-wk pregnant woman presented w/ sudden vision loss in her L eye after a typical migraine w/ visual aura. The aura persisted as a central scotoma. VA: R eye, 20/20; L eye, 20/200. Fundoscopy showed an area of retinal pallor. What is the diagnosis?
Complicated migraine
Optic neuritis
Toxoplasmosis
Retinal vein occlusion
Retinal artery occlusion
You are correct. Branch retinal artery occlusion presents as painless vision loss w/ retinal pallor along the distribution of the affected artery. Cause is usually embolic. Medical investigation in this pt included an echocardiogram, which revealed a patent foramen ovale. PFO is a recognized cause of a right-to-left shunt, which is a risk factor for an ischemic event secondary to a paradoxical embolus.