Abstract
A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.
Keywords:
TB and other respiratory infections; contraindications and precautions; neuroopthalmology; stroke; visual pathway.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
MeSH terms
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Aspirin / administration & dosage*
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Atrial Fibrillation* / complications
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Atrial Fibrillation* / drug therapy
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Betacoronavirus / isolation & purification
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Blindness* / diagnosis
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Blindness* / etiology
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Brain Stem Infarctions* / diagnostic imaging
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Brain Stem Infarctions* / drug therapy
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Brain Stem Infarctions* / physiopathology
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COVID-19
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Coronavirus Infections* / complications
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Coronavirus Infections* / diagnosis
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Coronavirus Infections* / physiopathology
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Diplopia* / diagnosis
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Diplopia* / etiology
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Endocarditis, Bacterial* / complications
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Endocarditis, Bacterial* / diagnosis
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Endocarditis, Bacterial* / physiopathology
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Factor Xa Inhibitors / administration & dosage
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Humans
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Magnetic Resonance Imaging / methods
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Male
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Middle Aged
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Ophthalmoplegia* / diagnosis
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Ophthalmoplegia* / etiology
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Pandemics*
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Platelet Aggregation Inhibitors / administration & dosage
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Pneumonia, Viral* / complications
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Pneumonia, Viral* / diagnosis
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Pneumonia, Viral* / physiopathology
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Pyrazoles / administration & dosage*
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Pyridones / administration & dosage*
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Retinal Artery Occlusion* / diagnostic imaging
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Retinal Artery Occlusion* / drug therapy
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Retinal Artery Occlusion* / etiology
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Retinal Artery Occlusion* / physiopathology
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SARS-CoV-2
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Tomography, Optical Coherence / methods
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Treatment Outcome
Substances
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Factor Xa Inhibitors
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Platelet Aggregation Inhibitors
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Pyrazoles
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Pyridones
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apixaban
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Aspirin