Cotton Wool Spots in Giant Cell Arteritis

This is a case of cotton wool spots in a patient with temporal artery-biopsy proven temporal arteritis.; ; A 66-year-old woman presents with isolated painless vision loss related to a left optic neuropathy in her left eye. She denies systemic symptoms to suggest giant cell arteritis.; Her examination shows: visual acuity: 20/20 OD, 20/40 OS, pupils: 1+ left RAPD, color vision: 14/14 OU correct Ishihara plates. She has the following bloodwork: erythrocyte sedimentation rate 47 mm/hr (normal 1-30), c-reactive protein 2.79 mg/L (normal < 8), platelets 329 (normal 150-450). A MRI brain with and without contrast was normal.; The patient's vision loss was attributed to a posterior ischemic optic neuropathy of the left eye. The presence of cotton wool spots and ischemic optic neuropathy in an elderly patient raised concern for giant cell arteritis. A left temporal artery biopsy was positive for giant cell arteritis. The patient was treated with corticosteroids. Color fundus photographs taken following treatment showed resolution of her peripapillary cotton wool spots.