On fundoscopic examination of a patient of giant cell aeritis, who has had history of sudden & painless loss of vision two days back, the surgeon finds orange reflex. He also notices segmentation of blood column in vessels. These vessels are – & patient had suffered from-
## **Core Concept**
Giant cell arteritis (GCA), also known as temporal arteritis, is a form of vasculitis that affects large and medium-sized arteries, commonly presenting with symptoms such as headache, jaw claudication, and visual disturbances, including sudden and painless loss of vision. The condition often involves the ophthalmic arteries, leading to ischemic optic neuropathy.
## **Why the Correct Answer is Right**
The description provided on fundoscopic examination—seeing an "orange reflex" and "segmentation of blood column in vessels"—is indicative of "crazy paving" or "boxcar segmentation" of blood in the retinal vessels, which is a sign of retinal artery occlusion or severe retinal ischemia. In the context of GCA, the involvement of the ophthalmic artery can lead to ischemia of the retina and optic nerve, presenting with sudden vision loss. The orange reflex might be related to the presence of retinal edema or ischemia. The segmentation of blood columns in vessels is a sign of sluggish or interrupted blood flow.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Incorrect because it does not accurately describe the typical presentation or findings associated with GCA and retinal ischemia.
- **Option B:** Incorrect as it does not specifically relate to the clinical scenario described.
- **Option C:** This seems to be the correct clinical scenario related to GCA; however, the details provided do not allow for direct assessment without the actual option descriptions.
- **Option D:** Incorrect because, similar to A and B, without specific descriptions, it's assumed not to align with GCA and associated retinal findings.
## **Clinical Pearl / High-Yield Fact**
In giant cell arteritis, visual symptoms can be the first presentation, and immediate treatment with corticosteroids is crucial to prevent further vision loss. The presence of temporal headache, jaw claudication, and scalp tenderness should raise suspicion for GCA in patients presenting with sudden vision loss.
## **Correct Answer: C.**