Bilateral Hypertensive Retinopathy Research Articles

Bilateral Exudative Retinal Detachment Due to Hypertensive Retinopathy and Choroidopathy In Young Patient with Chronic Kidney Disease

Introduction: Severe systemic hypertension in chronic kidney disease can cause significant damage to the eye. Although hypertensive retinopathy is a well-known complication, hypertensive optic neuropathy and choroidopathy are much less common. The aim of this study is to report retinal manifestation in young patient with chronic kidney disease.
 Method: A 26-year-old man with underlying disease chronic kidney disease (CKD) gr-V underwent bilateral bullous exudative retinal detachments. Retinal arteriolar narrowing, vascular tortuosity, arteriovenous nicking, optic disc swelling, retinal haemorrhage, elschnig spot, siegrist streak were identified in both eyes. Blood pressure was 200/140mmHg with visual acuity 0,5/60 OU. The patient was diagnosed with bilateral hypertensive retinopathy and choroidopathy with bulous exudative retinal detachments.
 Results: After antihypertensive treatment, visual acuity improved, but the exudative retinal detachments and retinal hemorrhages reduced. A patient with those findings should be considered as having hypertensive retinopathy and choroidopathy and treated as soon as possible because of the poor prognostic.
 Conclusion: Hypertensive choroidopathy is a rare finding associated with acute increases in blood pressure. When the choroid is associated, the hypertensive event is often more acute and associated with increased morbidity. It is necessary to obtain fundus exam in any patient with elevated blood pressure and concomitant vision complaints. Therefore, screening hypertensive patients involves close collaboration between internist and ophthalmologist.

Hypertensive retinopathy in the end-stage renal failure – study case.

The case of 26-year-old woman with a transient deterioration of binocular vision secondary to chronic renal failure due to glomerulonephritis is presented. The patient reported the onset of the disease at the age of 2. As her kidney disease was poorly controlled, she developed renal hypertension followed by bilateral hypertensive retinopathy. The patient was hospitalized intheDepartment of Nephrology, where she received dialyses and her blood pressure was normalised. The follow up intheOphthalmology Clinic was continued for 9 months. The treatment of her primary disease resulted in a significant resolution of retinopathy and improved her visual acuity.

BILATERAL OCCIPITAL POLE HYPERTENSIVE STROKE DIAGNOSED WITH MACULAR INTEGRITY ASSESSMENT (MAIA) MICROPERIMETRY

To describe the utility of microperimetry testing in the diagnosis of a bilateral occipital stroke. Retrospective case report. A 57-year-old male with hypertension presented with complaints of bilateral blurred central vision and bilateral hypertensive retinopathy with cotton-wool spots. Automated perimetry demonstrated a central scotoma in both eyes that did not respect the vertical midline; however, microperimetry testing revealed a bilateral homonymous hemianopia that suggested cerebrovascular disease which was subsequently confirmed with magnetic resonance imaging. In cases of unexplained central visual loss, microperimetry testing may be a useful ancillary test for the diagnosis of cerebrovascular disease.

A reversible cause of longitudinally extensive transverse myelopathy answer

D. Posterior reversible encephalopathy syndrome with spinal cord involvement Longitudinal transverse extensive myelitis (LETM) is defined as an inflammatory spinal cord lesion that appears on spinal MRI with high signal intensity on T2-weighted sequences and extends over three or more vertebral segments [[1]Trebst C. Raab P. Voss E.V. et al.Longitudinal extensive transverse myelitis–it’s not all neuromyelitis optica.Nat Rev Neurol. 2011; 7: 688-698Crossref PubMed Scopus (116) Google Scholar]. LETM arises secondary to a large number of etiologies, including neuromyelitis optica spectrum disorders and other demyelinating disorders, systemic inflammatory and autoimmune diseases, infectious diseases, neoplastic and paraneoplastic processes, and rarely, nutritional and vascular causes [[1]Trebst C. Raab P. Voss E.V. et al.Longitudinal extensive transverse myelitis–it’s not all neuromyelitis optica.Nat Rev Neurol. 2011; 7: 688-698Crossref PubMed Scopus (116) Google Scholar]. Posterior reversible encephalopathy syndrome (PRES) with spinal cord involvement can be present in several conditions, such as uncontrolled high blood pressure, renal failure and during the use of immunosuppressive agents [[2]Hinchey J. Chaves C. Appignani B. et al.A reversible posterior leukoencephalopathy syndrome.N Engl J Med. 1996; 334: 494-500Crossref PubMed Scopus (2706) Google Scholar]. Despite the usual association with parieto-occipital signal abnormalities, infratentorial and spine compromise have also been reported [2Hinchey J. Chaves C. Appignani B. et al.A reversible posterior leukoencephalopathy syndrome.N Engl J Med. 1996; 334: 494-500Crossref PubMed Scopus (2706) Google Scholar, 3de Havenon A. Joos Z. Longenecker L. et al.Posterior reversible encephalopathy syndrome with spinal cord involvement.Neurology. 2014; 83: 2002-2006Crossref PubMed Scopus (54) Google Scholar]. Spinal cord involvement in the context of PRES (PRES-SCI) is extremely rare, and gives rise to longitudinally extensive spinal lesions, frequently correlating with Grade IV hypertensive retinopathy [[3]de Havenon A. Joos Z. Longenecker L. et al.Posterior reversible encephalopathy syndrome with spinal cord involvement.Neurology. 2014; 83: 2002-2006Crossref PubMed Scopus (54) Google Scholar]. Therefore, PRES-SCI should be suspected in patients with longitudinally extensive transverse myelitis during hypertensive emergencies. The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication. A reversible cause of longitudinally extensive transverse myelopathy: questionJournal of Clinical NeuroscienceVol. 22Issue 11PreviewA 27-year-old man presented with a 5 day history of progressive headache with nausea, vomiting, blurred vision, weakness in the lower limbs and urinary incontinence. His past medical and familial histories were unremarkable. An examination revealed blood pressure of 230/140 mmHg, bilateral hypertensive retinopathy with papilledema, and mild paraparesis with brisk tendon reflexes. His blood tests revealed elevated creatinine (3.4 mg/dL) and urea (145 mg/dL) levels. The MRI scan of the brain and spine showed a longitudinally extensive signal change from the brainstem down to the mid-thoracic spine level, without contrast enhancement (Fig. Full-Text PDF

A reversible cause of longitudinally extensive transverse myelopathy: question

A 27-year-old man presented with a 5 day history of progressive headache with nausea, vomiting, blurred vision, weakness in the lower limbs and urinary incontinence. His past medical and familial histories were unremarkable. An examination revealed blood pressure of 230/140 mmHg, bilateral hypertensive retinopathy with papilledema, and mild paraparesis with brisk tendon reflexes. His blood tests revealed elevated creatinine (3.4 mg/dL) and urea (145 mg/dL) levels. The MRI scan of the brain and spine showed a longitudinally extensive signal change from the brainstem down to the mid-thoracic spine level, without contrast enhancement (Fig. 1). The tests for serum anti-aquaporin-4 immunoglobulin G antibodies, viral serologies and rheumatology, were negative. The cerebrospinal fluid examination was normal, with a negative polymerase chain reaction for herpes simplex virus (HSV-1 and HSV-2). He was commenced on parenteral and oral antihypertensive therapy, and a complete neurological improvement was observed after 4 days. The neuroimaging studies

A unique case of pheochromocytoma presenting with hypertensive retinopathy

Pheochromocytoma is an extremely uncommon tumor of childhood and there are several features that distinguish its presentation between adults and children. The incidence of pheochromocytoma in childhood is 10% of the adult incidence, occurring in approximately 1 in 500,000 children compared with 1 in 50,000 adults. Around 10% of childhood tumors are familial which is 4 times the frequency in adults. Whereas only 7% of pheochromocytomas are bilateral in adults, the reported incidence of the same in children range from 24% to as high as &70%.These tumors are known for their great diversity in clinical presentation. Greater than 50% of children present with headaches, fever, palpitation, thirst, polyuria, sweating, nausea and weight loss. However the commonest mode of presentation is sustained hypertension. Pheochromocytoma accounts for 0.5% of children with hypertension and must be considered once other causes have been eliminated. We here in report a unique case of a 13 year old girl who initially presented with bilateral hypertensive retinopathy and later found to have a pheochromocytoma on subsequent workup. Hypertensive retinopathy secondary to pheochromocytoma is itself a rare entity whose exact incidence in children is still unknown. This case highlights the importance of routine history, physical examination and measurement of bp. Prompt surgery can reverse the effect of hypertension and lead to good outcome as was evident in our case.

Laparoscopic adrenalectomy for management of a functional adrenal tumor in a cat

A 9-year-old castrated male domestic shorthair cat was examined because of hypertension that persisted after resolution of the patient's hyperthyroidism. Bilateral hypertensive retinopathy, a systolic heart murmur, left ventricular hypertrophy, and tachycardia were present. Biochemical analysis revealed mild hypokalemia, normonatremia, high serum creatine kinase activity, high serum aldosterone concentration, and low plasma renin activity consistent with hyperaldosteronism. Hypercalcemia with an associated high serum parathyroid hormone concentration and an exaggerated low-dose dexamethasone suppression test result were consistent with concurrent hyperparathyroidism and hyperadrenocorticism, respectively. Ultrasonographic examination revealed a markedly enlarged left adrenal gland, an abnormally small right adrenal gland, and 2 nodules in the right thyroid and parathyroid glands. Laparoscopic left adrenalectomy was performed concurrently with right thyroidectomy and parathyroidectomy. Histologic evaluation revealed an adrenal cortical adenoma, thyroid adenoma, and parathyroid adenoma. The cat recovered from surgery without complications. The hypercalcemia and hypertension resolved after surgery. Follow-up echocardiography revealed improvement in the left ventricular hypertrophy. Ultrasonographic examinations performed up to 26 months after adrenalectomy showed no evidence of regrowth of the adrenal mass. The patient survived for 44 months after adrenalectomy with no signs of recurrent hyperaldosteronism or hyperadrenocorticism. Laparoscopic adrenalectomy may be a plausible method for the treatment of unilateral functional adrenal neoplasia in feline patients when diagnostic imaging has ruled out intravascular invasion and metastatic disease. In addition, in a feline patient with hyperthyroidism and hypertension, other endocrine glands should be investigated.

Permanent Bilateral Cortical Blindness Due to Reversible Posterior Leukoencephalopathy Syndrome

Reversible posterior leukoencephalopathy syndrome (RPLS) is induced by acute cerebral edema. Its symptoms include seizures, headache, altered mental status, and visual disturbances. The clinical and radiological findings are usually transient. This report describes a case of RPLS resulting in bilateral total blindness. A 40-year-old man presented with lethargy and bilateral visual loss. He had a 20-year history of hypertension, but had never been treated. On presentation, the left eye was able to perceive light, but the right eye was not. Radiological examination showed diffuse edema in the brain, and ocular fundus examination revealed severe bilateral hypertensive retinopathy. Antihypertensive therapy improved the patient's general condition, including blood pressure. Radiological findings 5 months later showed resolution of most of the abnormal signal areas. However, total blindness had developed in both eyes by day 15, and two courses of pulsed corticosteroid therapy failed to restore the visual loss.

Severe Bilateral Hypertensive Retinopathy and Optic Neuropathy in a Patient with Pheochromocytoma

We present a case of severe bilateral hypertensive retinopathy and optic neuropathy due to pheochromocytoma. A 31-year-old woman presented with severe bilateral visual acuity loss associated with headaches and photophobia. Ophthalmoscopy showed bilateral optic disc edema, soft exudates, macular star, flame-shaped hemorrhages and arterial narrowing. The situation was more severe in the right eye. Fluorescein angiography confirmed the diagnosis of hypertensive retinopathy. Arterial blood pressure was 220/145 mmHg. A thorough systemic control revealed a right adrenal gland mass. Catecholamine secretion was normal. After ablation, the tumor proved to be a pheochromocytoma, and immunohistochemistry showed dopamine secretion. Postoperative evolution was uncomplicated. Antihypertensive treatment lasted only a few months. Visual acuity was restored and the retinal alterations disappeared 8 months after surgery. Severe hypertensive retinopathy with optic neuropathy may be a consequence of malignant hypertension due to a pheochromocytoma. It is reversible after ablation of the tumor. Early diagnosis is of vital importance and relies on hormonal investigation and immunohistochemistry.