The Retrobulbar “Spot Sign” as a Discriminator Between Vasculitic and Thrombo-Embolic Affections of the Retinal Blood Supply

Abstract

The detection of the "spot sign" specifically minimizes the probability of TA as a reason for sudden blindness.

Low Endogenous Recanalization in Embolic Central Retinal Artery Occlusion—The Retrobulbar “Spot Sign”

“…In a previous prospective study, in which our goal was to differentiate vasculitic from embolic CRAO leading to persistent loss of vision, we observed an echogenic structure with absent flow in the central retinal artery—termed “spot sign”—on orbital color‐coded sonography (OCCS) images in 10 (83%) of 12 patients, and we determined that the spot sign was highly predictive of embolic occlusion . Authors of another noncomparative, retrospective observational study reported a lower frequency of the spot sign (31%, 9 of 29 patients) in cases of sudden ocular blindness of an embolic nature .…”

“…From the 10 patients identified as having CRAO and a positive spot sign in our previous study, 7 patients agreed to a follow‐up examination. One of the original patients had died, and 2 other patients declined to participate.…”

“…In this study, we performed follow‐up examinations in patients from our previous study that had presented with CRAO and the sonographic spot sign . Persistence of the spot sign may be indicative of calcified emboli or even a cholesterol nature of the embolus (originating from so called “Hollenhorst plaques”) as fibrin containing emboli have a higher rate of spontaneous resolvement.…”

Retrobulbar Spot Sign Predicts Thrombolytic Treatment Effects and Etiology in Central Retinal Artery Occlusion

“…It may help discriminate vasculitic from embolic occlusion, as it does not seem to occur in vasculitis. 7 On the other hand, a spot sign is only found in a proportion of embolic CRAO. It has been suggested that it may represent a calcified portion of the embolus.…”

Teaching Neuro Images : Sonographic “retrobulbar spot sign” in differentiating etiologies of sudden visual loss

“…1 Transorbital examination revealed hyperechogenic retrobulbar spot sign (figure), which is highly specific for embolic occlusion of the central retinal artery. 2 Comprehensive diagnostic workup revealed paroxysmal atrial fibrillation as a putative cause for the embolus and no evidence for vasculitis. Thus, potentially harmful thrombogenic administration of steroids could be avoided.…”