Differential Diagnosis for Blindness in One Eye Following a Stroke
- Single most likely diagnosis
- Central Retinal Artery Occlusion (CRAO): This condition occurs when the central retinal artery, which supplies blood to the retina, becomes blocked. It can lead to sudden, painless loss of vision in one eye and is often associated with stroke risk factors. The sudden onset of blindness in one eye following a stroke makes CRAO a highly plausible diagnosis.
- Other Likely diagnoses
- Optic Neuritis: Inflammation of the optic nerve can cause vision loss, which might be perceived as blindness. While it's more commonly associated with multiple sclerosis, it can occur in the context of a stroke, especially if there's an inflammatory component.
- Posterior Ischemic Optic Neuropathy (PION): This condition involves ischemia to the optic nerve and can result in sudden vision loss. It's less common than CRAO but can be associated with systemic diseases and conditions that also increase stroke risk.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Giant Cell Arteritis (GCA): Although less common, GCA can cause sudden blindness in one eye due to ischemia of the optic nerve. It's critical to consider GCA because it can lead to blindness in the other eye if not promptly treated with corticosteroids.
- Carotid Artery Dissection: Dissection of the carotid artery can lead to stroke and, if affecting the ophthalmic artery, can cause blindness in one eye. Early diagnosis is crucial for appropriate management to prevent further complications.
- Rare diagnoses
- Susac Syndrome: A rare condition characterized by microangiopathic changes affecting the brain, retina, and inner ear. It can present with sudden vision loss among other symptoms and is important to consider in young adults with unexplained stroke and vision loss.
- Migraine-related Blindness: In rare cases, migraines can cause transient or, very rarely, permanent blindness in one eye. While not directly related to stroke, the differential diagnosis of sudden vision loss should include migraine phenomena, especially if there's a history of migraines.