Acute Blindness In An Athlete

Abstract

TITLE: Acute Blindness in an Athlete PRESENTER: Sarah Abdellatif, DO HISTORY: A 24 yo weightlifter with a past medical history of mitral valve prolapse and Raynaud’s syndrome experienced sudden right eye blindness about one month ago after training at the gym. She finished her session at the gym that day with no issues. Once patient returned home, she decided to sit down and read for a bit when she suddenly lost vision of her right eye. She had no precipitating symptoms. Patient took an aspirin and her vision returned in about thirty minutes. She states that the image was slightly pixelated when it returned. Patient had never had anything like this happen before and had not happened again after that episode. PHYSICAL EXAMINATION: Height- 66 inches Weight- 112 pounds Blood Pressure- 132/76HEENT- Extraocular movements intact. Pupils equal and reactive to light.Neck- JVP normal, carotid pulses are full and equal bilaterally without bruitsCardiac- Regular rhythm and rate, S1 normal, S2 normal, so S3 or S4, no murmurs, no gallops, no rubs detectedPeripheral Pulses- Femoral, popliteal, dorsalis pedis, and posterior tibial pulses are full and equal bilaterally with no bruits auscultated.Neuro- Cranial nerves 2-12 intact. DIFFERENTIAL DIAGNOSIS: 1. Patent Foramen Ovale 2. Central Retinal Artery Occlusion 3. Carotid Stenosis 4. Hemiplegic Migraine 5. Multiple Sclerosis TEST AND RESULTS: Complete 2D Echocardiogram-- The left ventricular systolic function is normal with an estimated EF 60-64%.- Patent foramen ovale is seen with left to right shunting.- Qp:Qs ratio is 0.72.- There are no hemodynamically significant valvular abnormalities or insufficiencies noted on this study. FINAL/WORKING DIAGNOSIS: Large bidirectional shunting via patent foramen ovale with possible aborted central retinal artery occlusion stroke TREATMENT AND OUTCOMES: 1. Start aspirin and Plavix daily. 2. TEE and a cardiac CTA to include origin of great vessels and carotid arteries. 3. Check a seven day cardiac monitor. 4. Schedule for PFO closure once results return. Risks and benefits discussed, given patient’s level of activity. 5. Refer to stroke neurologist for multidisciplinary evaluation.