Purtscher-Like Retinopathy with Cardioembolic Stroke: Case Report and Literature Review

Abstract

Purtscher-like retinopathy (PUR) is a rare condition characterized by sudden vision loss with associated retinal white patches thought to be due to precapillary arteriolar occlusion. We present a case of PUR associated with a cardioembolic stroke in a patient following temporary cessation of anticoagulant therapy for a surgical procedure. Our patient presented with multiple risk factors for PUR and classic signs and symptoms including multiple peripapillary white retinal lesions near arterioles and sudden unilateral decrease in visual acuity. Optical coherence tomography showed inner retinal hyperreflectivity and thinning consistent with inner retinal ischemia, and fluorescein angiography showed delayed retinal filling. Her complement C5 factor was elevated on laboratory testing. Brain magnetic resonance imaging showed acute/subacute left occipital lobe ischemia thought to be from a cardioembolic stroke. Shortly prior to visual symptoms, our patient’s apixaban was held due to surgical drainage of a gluteal abscess. This case highlights the rare occurrence of PUR associated with cardioembolic stroke and the importance of cerebral imaging in a patient presenting with PUR of uncertain etiology.