Case Report: Paracentral Acute Middle Maculopathy Following Carotid Artery Dissection

Muhi Dean Barazi^1*Yusuf Bade²Malek Zanbrakji³Patrick A Stone⁴Omar Belal Sabbagh⁵Mohsin H Ali⁶Alexander Melamud⁶

• ¹Rice University, Houston, United States
• ²School of Medicine and Health Sciences, George Washington University, Washington, D.C., District of Columbia, United States
• ³Georgetown University, Washington, District of Columbia, United States
• ⁴Vanderbilt University, Nashville, Tennessee, United States
• ⁵West Virginia University, Morgantown, West Virginia, United States
• ⁶The Retina Group of Washington, Reston, VA, United States

Background: Paracentral acute middle maculopathy (PAMM) is a rare, presumed ischemic maculopathy. While primarily associated with retinal vascular pathologies, several case studies have documented PAMM diagnoses following systemic cardiovascular events or interventions. Here, we discuss a case of PAMM development after carotid artery dissection (CAD).Case Presentation: A woman in her late 30s presented to the emergency department with transient right-side weakness and amaurosis in her left eye lasting 1-2 hours. An initial stroke and embolic workup showed no significant findings. She later presented to the retina clinic with normal visual acuity and intraocular pressure. Dilated fundus examination, intravenous fluorescein angiography, and spectral-domain optical coherence tomography (SD-OCT) were unremarkable. Several days later, the patient returned to the emergency department complaining of transient ride-sided paresthesia, transient facial weakness, and dysarthria. A computed tomography angiogram revealed a dissection of the left internal carotid artery. Repeated retinal evaluation revealed a hyperreflective band on SD-OCT, characteristic of PAMM, spanning from the inner plexiform layer to the outer plexiform layer. Subsequent SD-OCT scans showed a resolution of the acute hyperreflective PAMM lesion with corresponding attenuation of the affected inner nuclear layer. Follow-up visits indicated a residual inferior paracentral scotoma in the affected eye.Conclusions: This case illustrates the rare occurrence of PAMM associated with CAD, underscoring the link between systemic vascular events and retinal ischemia, and demonstrating the potential of PAMM as an early indicator of the causative vascular pathology.