Subject(s)
COVID-19 , Retinal Artery Occlusion , COVID-19/blood , COVID-19/complications , COVID-19/epidemiology , Humans , Patient Care/methods , Retinal Artery Occlusion/epidemiology , Retinal Artery Occlusion/etiology , Retinal Artery Occlusion/physiopathology , Retinal Artery Occlusion/therapy , Risk Factors , SARS-CoV-2ABSTRACT
A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.