{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T18:24:10Z","timestamp":1775240650040,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,11,21]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:p>A man in his 60s presented with a subacute paracentral scotoma and preserved visual acuity in the left eye. He was found to have a very subtle area of deep retinal whitening at the macula and multiple retinal cholesterol emboli. Optical coherence tomography (OCT) with En face imaging revealed globular paracentral acute middle maculopathy (PAMM). A diagnosis of PAMM associated with branch artery occlusion was made and the patient was immediately transferred to the nearest stroke centre. Investigations revealed severe carotid occlusive disease for which the patient underwent carotid endarterectomy. Paracentral scotomas in patients with little clinical findings on fundus examination should raise the suspicion for PAMM, which is easily identifiable on OCT. Eye care professionals must recognise PAMM as a possible sign of acute retinal arterial ischaemia\u2014an ocular and systemic emergency that requires immediate referral to specialised stroke centres.<\/jats:p>","DOI":"10.1136\/bcr-2022-252266","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T10:05:45Z","timestamp":1669629945000},"page":"e252266","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Acute retinal ischaemia associated with paracentral acute middle maculopathy detected on multimodal imaging: a premonitory sign of severe carotid occlusive disease"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6679-7276","authenticated-orcid":false,"given":"Fares","family":"Antaki","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"},{"name":"Department of Ophthalmology, Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al (CHUM), Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Milad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"},{"name":"Department of Ophthalmology, Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al (CHUM), Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thierry","family":"Hamel","sequence":"additional","affiliation":[{"name":"Clinique d'Ophthalmologie Brome-Missisquoi, Cowansville, Qu\u00e9bec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,11,28]]},"reference":[{"key":"2025082709584593000_15.11.e252266.1","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000000785"},{"key":"2025082709584593000_15.11.e252266.2","doi-asserted-by":"crossref","first-page":"2583","DOI":"10.1007\/s00417-020-04826-1","article-title":"Paracentral acute middle maculopathy-review of the literature","volume":"258","author":"Moura-Coelho","year":"2020","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"2025082709584593000_15.11.e252266.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40942-021-00283-y","article-title":"Multimodal imaging for paracentral acute maculopathy; the diagnostic role of en face OCT","volume":"7","author":"Riazi-Esfahani","year":"2021","journal-title":"Int J Retina Vitreous"},{"key":"2025082709584593000_15.11.e252266.4","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1016\/j.ophtha.2018.03.054","article-title":"Management of acute retinal ischemia: follow the guidelines!","volume":"125","author":"Biousse","year":"2018","journal-title":"Ophthalmology"},{"key":"2025082709584593000_15.11.e252266.5","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1001\/jamaophthalmol.2013.4056","article-title":"Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia","volume":"131","author":"Sarraf","year":"2013","journal-title":"JAMA Ophthalmol"},{"key":"2025082709584593000_15.11.e252266.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2009.03.006"},{"key":"2025082709584593000_15.11.e252266.7","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000023445.20454.A8"},{"key":"2025082709584593000_15.11.e252266.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2011.05.001"},{"key":"2025082709584593000_15.11.e252266.9","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-246842","article-title":"Paracentral acute middle maculopathy in non-ischaemic central retinal vein occlusion: the role of en face optical coherence tomography","volume":"14","author":"Antaki","year":"2021","journal-title":"BMJ Case Rep"},{"key":"2025082709584593000_15.11.e252266.10","doi-asserted-by":"crossref","unstructured":"Zhao PY , Johnson MW , McDonald HR . 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