A 62-year-old man with a history of atrial fibrillation presents with sudden, profound unilateral vision loss. Fundoscopy shows a pale retina with a cherry-red spot and no embolus is visible. Carotid Doppler is normal. What is the most likely source of the occlusion?
- A Cardioembolism from the left atrium ✓
- B Cholesterol embolus from the aortic arch
- C Carotid artery atherosclerotic plaque
- D Giant cell arteritis of the ophthalmic artery
Correct answer: A. Cardioembolism from the left atrium
Explanation
In central retinal artery occlusion with atrial fibrillation and a normal carotid study, a cardioembolic source is most likely. Atrial fibrillation produces thrombi in the left atrial appendage that embolize to the retinal circulation. Option C is ruled out by the normal Doppler. Option B would be visible as a Hollenhorst plaque. Option D presents with different systemic symptoms and age profile.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.