An elderly patient presented to the BPEI Emergency Room 3 hours after onset of painless vision loss. Past medical history included hypertension and atrial fibrillation treated with apixaban, of which the patient reported good adherence. The patient had no other signs or symptoms of an acute stroke. As the patient presented within the stroke window, she was urgently transferred for neurology evaluation and potential reperfusion therapy. Given age, risks of reperfusion therapy, and concurrent use of apixaban, reperfusion was not performed. An elevated ESR/CSR in the setting of advanced age raised the possibility of giant cell arteritis (GCA). The patient however reported a negative review of systems (no temporal pain, jaw claudication, polymyalgia or other constitutional symptoms), and upon repeat serologic testing, ESR/CRP levels were noted to be decreased. Patient was treated with observation alone. At last follow up, no stroke was noted and no loss of vision occurred in the contralateral eye.
Presentation Date: 02/16/2023
Issue Date: 03/03/2023