Paracentral Acute Middle Maculopathy Presenting as a Sign of Impending Central Retinal Artery Occlusion: A Case Report

Background: To report a case of paracentral acute middle maculopathy (PAMM) that progressed to central retinal artery occlusion (CRAO) on spectral domain-optical coherence tomography (SD-OCT). Case Presentation A 63-year-old male presented with a paracentral scotoma that began several days ago. His past medical history consisted of third degree atrioventricular heart block requiring a pacemaker. Giant cell arteritis was ruled out after erythrocyte sedimentation rate and c-reactive protein levels were normal. SD-OCT revealed a characteristic hyperreflective band in the inner nuclear layer consistent with PAMM in his left eye. Fluorescein angiography was obtained and demonstrated an area of non-perfusion in the parafoveal region. Five days later, the patient developed no light perception in the left eye. SD-OCT showed a diffuse inner retinal hyperreflectivity consistent with CRAO. Conclusion: PAMM can be a harbinger event for complete CRAO. Complete stroke evaluation should be performed to prevent a cerebrovascular event or progression to complete blindness in the involved eye.