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.