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CRAO Secondary to GCA — SCE Neurology MCQ

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ModerateNeuro-ophthalmologyCRAO Secondary to GCASCE Neurology

A 75-year-old woman presents with sudden-onset painless visual loss in the right eye. Visual acuity is light perception only. There is a right RAPD. Fundoscopy shows a pale retina with a cherry-red spot at the macula. ESR is 65 mm/hr and CRP is 45 mg/L. She also reports jaw claudication. What is the most likely diagnosis?

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Correct answer: C — Central retinal artery occlusion secondary to giant cell arteritis

A cherry-red spot at the macula indicates central retinal artery occlusion (CRAO). In an elderly patient with elevated inflammatory markers (ESR 65, CRP 45) and jaw claudication, the cause is giant cell arteritis (GCA) until proven otherwise. This is a medical emergency — the contralateral eye is at imminent risk of visual loss. High-dose IV methylprednisolone must be started immediately and an urgent temporal artery biopsy arranged. A: Atherosclerotic CRAO would not explain the raised inflammatory markers and jaw claudication. C: Optic neuritis does not cause a cherry-red spot. D: Retinal detachment has a different fundoscopic appearance. E: Vitreous haemorrhage obscures the fundus view.

Reference: BSR/BHPR GCA Guidelines (2020); ABN Neuro-ophthalmology Guidelines