title: Multiple branch retinal arteriolar occlusions associated with smallpox vaccination.
abstract: We describe a rare combination of multiple multiple branch retinal arteriolar occlusions (BRAO) and encephalopathy, which developed in an adult male 10 days after smallpox vaccination. A 53-year-old physician presented with sudden temporal visual field loss in the left eye. Ten days earlier he had received a smallpox vaccination. Hyperbaric oxygen was administered because of suspected BRAO. Examination on day 3 revealed a decrease in visual acuity and loss of visual field. Fundoscopy of the left eye disclosed a retinal infarct in the inferior macula and multiple cotton wool spots over the entire posterior pole. Fluorescein angiography showed delayed arterial filling and multiple non-perfused areas. Magnetic resonance imaging of the brain disclosed white matter focal lesions. Neurological examination was normal. Audiological examination revealed mild hearing loss caused by an old phonic trauma. A combination of intravenous methylprednisolone and immunoglobulins, recommended for the treatment of Susac syndrome, was administered. At the follow-up visit 3 months later, visual acuity in the left eye improved, fundoscopy showed resolution of the cotton wool spots and temporal disc pallor, and the visual field was substantially restored.
authors.affiliation: Department of Ophthalmology, Kaplan Medical Center, 76100 Rehovot, Israel. genal@inter.net.il
authors.forename: Gennady
authors.initials: G
authors.lastname: Landa
authors.forename: Arie
authors.initials: A
authors.lastname: Marcovich
authors.forename: Hana
authors.initials: H
authors.lastname: Leiba
authors.forename: Amira
authors.initials: A
authors.lastname: Springer
authors.forename: Amir
authors.initials: A
authors.lastname: Bukelman
authors.forename: Ayala
authors.initials: A
authors.lastname: Pollack
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D006801:Humans; D006931:Hyperbaric Oxygenation; D007136:Immunoglobulins / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D015356:Retinal Artery Occlusion / Q000139:chemically induced* / Q000628:therapy; D012900:Smallpox Vaccine / Q000009:adverse effects*
chemical_list: D000893:Anti-Inflammatory Agents; D007136:Immunoglobulins; D012900:Smallpox Vaccine; D008775:Methylprednisolone