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80-year-old woman who I saw in the office on January 15, 2009. She was previously seen by me. She had in mid 2000 a dark film in the vision in the left eye and then when I saw her, she had a spot in the inferior vision in the left eye. At that time she had an old sclerosed inferotemporal branch retinal vein occlusion in the left eye, but there were multiple cotton wool spots in that eye. Her blood pressure was fine and her work-up at the time was unrewarding. I thought maybe she had a central retinal artery occlusion, which spontaneously aborted, now one month ago she had a similar episode in the right eye where she had vision loss and a vascular occlusion. Discussing her previous history with her, she does today although not on previous visits note that she had severe tinnitus and ringing in the ears since the 1980s. She does have mild hearing loss, although she said she was tested and she actually did a fair amount better than her husband, who now has hearing aids. She has not complained of any headaches. VISUAL ACUITY: OD 20/400, OS 20/40. IOP: 13 OU. SLIT EXAMINATION: There is trace corneal edema and the posterior chamber intraocular lens is in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There are cotton wool spots inferior to the optic nerve. There is a sclerose superotemporal branch retinal artery. OS: Vertical C/D ratio is 0.1. There is a slerose inferotemporal branch retinal artery. OCT SCAN: The OCT scan of the right eye shows severe retinal atrophy superior to the midline. The inferior retina looks to be okay. The OCT scan of the left eye shows a near normal macular thickness. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: The fluorescein angiogram shows a superotemporal macular branch retinal vein occlusion in the right eye. There is normal circulation in the inferotemporal branch retinal artery and the left eye shows normal circulation to all but the very far peripheral retinal arterials in the inferotemporal quadrant of the left eye. IMPRESSION: 1. MULTIPLE RECURRENT BRANCH RETINAL ARTERY OCCLUSIONS 2. COTTON WOOL SPOTS – RIGHT EYE 3. POSSIBLE SUSAC SYNDROME DISCUSSION: I explained to the patient she does unfortunately have a branch retinal artery occlusion in the right eye. It looks like in the right eye similar to the episode she has in the left eye. She had an event that affected both the superotemporal and inferotemporal branch retinal arterial, but then the inferotemporal branch retinal arterial re-profused. She has a very atypical picture; most patients with branch retinal artery occlusions from emboli do not develop sclerosis of the retinal arterials. She now has sclerosis of the retinal arterial in the left eye and the right eye and that combined with tinnitus makes me suspicious she may have Susac syndrome. A diagnostic test for this is an MRI scan, which typically shows problems with the white matter, especially in the corpus callosum. I have taken the liberty of scheduling for an MRI scan at the diagnostic clinic, with and without contrast of her brain. I asked her to return here for a check in three months or sooner if she should notice a problem and I asked her to see you back regularly. If she does indeed have Susac syndrome, the treatment of choice is not anti-coagulation, but rather anti-inflammatory medications. In the acute phase steroids are sometimes used and in the chronic phase in her is without any symptoms of encephalopathy, I do not think treatment is necessary. I asked her to return here urgently should she have a problem. Thank you for allowing

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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 363 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 228 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 182 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 182 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 186 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 130 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 148 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 119 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 109 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 94 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 99 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 96 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 93 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 113 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 90 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 117 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 124 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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Bilateral Retinal Arteriol Occlusions - Possible Susac Syndrome 147 views80-year-old woman one month ago had vision loss and a vascular occlusion in the right eye. Vision loss occurred in the left eye about 9 years ago with cotton wool spots. Patients has a 30 year history of tinnitis.
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80-year-old woman who I saw in the office on January 15, 2009. She was previously seen by me. She had in mid 2000 a dark film in the vision in the left eye and then when I saw her, she had a spot in the inferior vision in the left eye. At that time she had an old sclerosed inferotemporal branch retinal vein occlusion in the left eye, but there were multiple cotton wool spots in that eye. Her blood pressure was fine and her work-up at the time was unrewarding. I thought maybe she had a central retinal artery occlusion, which spontaneously aborted, now one month ago she had a similar episode in the right eye where she had vision loss and a vascular occlusion. Discussing her previous history with her, she does today although not on previous visits note that she had severe tinnitus and ringing in the ears since the 1980s. She does have mild hearing loss, although she said she was tested and she actually did a fair amount better than her husband, who now has hearing aids. She has not complained of any headaches. VISUAL ACUITY: OD 20/400, OS 20/40. IOP: 13 OU. SLIT EXAMINATION: There is trace corneal edema and the posterior chamber intraocular lens is in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There are cotton wool spots inferior to the optic nerve. There is a sclerose superotemporal branch retinal artery. OS: Vertical C/D ratio is 0.1. There is a slerose inferotemporal branch retinal artery. OCT SCAN: The OCT scan of the right eye shows severe retinal atrophy superior to the midline. The inferior retina looks to be okay. The OCT scan of the left eye shows a near normal macular thickness. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: The fluorescein angiogram shows a superotemporal macular branch retinal vein occlusion in the right eye. There is normal circulation in the inferotemporal branch retinal artery and the left eye shows normal circulation to all but the very far peripheral retinal arterials in the inferotemporal quadrant of the left eye. IMPRESSION: 1. MULTIPLE RECURRENT BRANCH RETINAL ARTERY OCCLUSIONS 2. COTTON WOOL SPOTS – RIGHT EYE 3. POSSIBLE SUSAC SYNDROME DISCUSSION: I explained to the patient she does unfortunately have a branch retinal artery occlusion in the right eye. It looks like in the right eye similar to the episode she has in the left eye. She had an event that affected both the superotemporal and inferotemporal branch retinal arterial, but then the inferotemporal branch retinal arterial re-profused. She has a very atypical picture; most patients with branch retinal artery occlusions from emboli do not develop sclerosis of the retinal arterials. She now has sclerosis of the retinal arterial in the left eye and the right eye and that combined with tinnitus makes me suspicious she may have Susac syndrome. A diagnostic test for this is an MRI scan, which typically shows problems with the white matter, especially in the corpus callosum. I have taken the liberty of scheduling for an MRI scan at the diagnostic clinic, with and without contrast of her brain. I asked her to return here for a check in three months or sooner if she should notice a problem and I asked her to see you back regularly. If she does indeed have Susac syndrome, the treatment of choice is not anti-coagulation, but rather anti-inflammatory medications. In the acute phase steroids are sometimes used and in the chronic phase in her is without any symptoms of encephalopathy, I do not think treatment is necessary. I asked her to return here urgently should she have a problem. Thank you for allowing