Case description
A 64-year-old man with type 2 diabetes was examined with a severe headache and mild visual acuity decrease in his right eye. On examination, his best-corrected visual acuity was 20/30 in his right eye and 20/20 in the left. While left fundus was normal, there was peripapillary cotton-wool spots with an intact foveal architecture in his right eye (Figure 1). A diagnosis of right Purtscher-like retinopathy was made. A detailed systemic workup was carried out and right internal carotid artery catheter angiography demonstrated the presence of the spiral dissection of right internal carotid artery (Figure 2). The diagnosis of Purtscher-like retinopathy is clinical with a presentation that usually includes sudden unilateral or bilateral visual disturbance of variable severity. It is characterized with several retinal findings, such as cotton-wool spots, retinal hemorrhages, and areas of inner retinal whitening namely Purtscher flecken. A multitude of various systemic diseases has been described as the cause.1 Very recently Qazi et al.2 reported a 40-year-old woman with an unilateral Purtscher-like retinopathy. Two days earlier, she had an ischemic stroke of her middle cerebral artery secondary to a right carotid artery dissection. Whenever a diagnosis of Purtscher-like retinopathy is made, underlying diseases should be scrutinized meticulously.