Central Retinal Artery Occlusion: Early Diagnosis With Advanced Ultrasound Transorbital Doppler Imaging.

Merli, Nicola; Inchingolo, Vincenzo; Malferrari, Giovanni; Pugliatti, Maura; Paciaroni, Maurizio · Neurology · 2026

case_report · Level V

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Abstract

A 62-year-old man presented with sudden, painless, complete vision loss in left eye upon nocturnal awakening. Ophthalmoscopy revealed pale retina and cherry-red spot, suggestive of central retinal artery occlusion (CRA-O). Brain CT-angiography was normal, and left internal carotid artery ultrasound examination showed <50% calcific stenosis (Figure 1A). Macular optic coherence tomography was consistent with suspicion (Figure 1B). Transorbital Doppler sonography (TDS) performed at presentation revealed a hyperechoic spot sign posterior to the optic nerve head, representing a CRA distal fibrocalcific thrombus (Figure 2, Video 1).<sup>1</sup> No Power-Doppler spectral signal from CRA was detectable (Figures 1, C–D and 2B–D; Video 1).