A 71-Year-Old Man Comes to the Emergency Department Due to Sudden-Onset

question 157

Multiple Choice

A 71-year-old man comes to the emergency department due to sudden-onset vision loss in his left eye for one hour.  He has a history of coronary artery disease, hypertension, and type 2 diabetes mellitus.  Blood pressure is 145/80 mm Hg and pulse is 72/min.  On examination, the patient can see only hand motions through the left eye.  Funduscopic evaluation of the eye shows a cherry-red spot in the macula with surrounding retinal whitening.  Cranial nerve examination is otherwise unremarkable.  There is a left-sided neck bruit on cardiovascular examination.  Which of the following is the most likely path of the embolus causing this patient's symptoms?

• A)External carotid artery, facial artery, ophthalmic artery, retinal artery
• B)External carotid artery, ophthalmic artery, retinal artery
• C)External carotid artery, temporal artery, retinal artery
• D)Internal carotid artery, anterior cerebral artery, retinal artery
• E)Internal carotid artery, ophthalmic artery, retinal artery

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