Malignant Hypertension With Bilateral Optic Nerve Edema

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Identifier EEC-Malignant_Hypertension_NOVEL
Title Malignant Hypertension With Bilateral Optic Nerve Edema
Creator Rahul A. Sharma, MD, MPH; Michael Dattilo, MD, PhD; Valérie Biousse, MD
Affiliation (RAS) Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; (MD) Assistant Professor of Ophthalmology, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; (VB) Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, Georgia
Subject Hypertension, Disc Edema, Occipital Lobe Hemorrhage
Description This is a case of malignant hypertension and severe hypertensive retinopathy. A 30-year-old woman with headache and vision loss in the left eye was found to have a markedly elevated blood pressure of 205/100. CT head without contrast showed acute hemorrhage in the right temporal-occipital junction and occipital horn of the lateral ventricle (Figure 1). Photographs of the posterior pole of the retina in both eyes two days following presentation showed retinal arterial narrowing with focal irregularities, retinal hemorrhages, exudates and cotton wool spots in both eyes (Figure 2). Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) showed increased RNFL thickness in both eyes, consistent with bilateral optic nerve edema (Figure 3). OCT macula showed an exudative retinal detachment in the right eye (Figure 4). Humphrey visual fields (24-2 SITA Fast) showed a left homonymous hemianopia as well as generalized depression in both eyes (Figure 5). She was diagnosed with a left homonymous hemianopia due to a right occipital lobe hemorrhage and malignant hypertensive retinopathy in both eyes. Figure 1. Color photographs of both eyes, centered on the optic nerves, showed bilateral optic nerve edema, cotton wool spots, hard exudates, flame-shaped retinal hemorrhages and arteriovenous (AV) nicking. Figure 2. CT Head without contrast showed an acute hemorrhage in the right temporal occipital junction and occipital horn of the lateral ventricle (Figure 2). CT angiogram and cerebral angiogram were normal.Figure 3. Optical Coherence Tomography (OCT) of the retinal nerve fiber layer (RNFL) shows increased RNFL thickness in both eyes, consistent with bilateral optic nerve edema. Figure 4. Spectralis optical coherence tomography (OCT) of the macula showed bilateral optic nerve edema, macular hard exudates (both eyes) and subretinal fluid (right eye). Figure 5. Humphrey visual fields (24-2 SITA Fast) showed a complete left homonymous hemianopia (red outline) due to the right temporal-occipital hemorrhage, as well as non-specific changes in both eyes due to hypertensive retinopathy affecting both eyes.
Date 2020-01
Language eng
Format application/pdf
Format Creation Microsoft PowerPoint
Type Text
Collection Neuro-Ophthalmology Virtual Education Library: The Emory Eye Center Collection: https://novel.utah.edu/eec/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2002. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s66m880x
Setname ehsl_novel_eec
ID 1511193
Reference URL https://collections.lib.utah.edu/ark:/87278/s66m880x
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