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Bilateral Exudative Multifocal Retinal Detachment: An Unusual Presentation of Accelerated Hypertension with Obstructive Uropathy
並列摘要
Introduction: ＂We report a case of accelerated hypertension with obstructive uropathy presenting with four days history of headache and profound loss of vision due to exudative retinal detachment, macular ischemia and bilateral hypertensive choroidopathy in young adult. Case Report: A 27-yr-old male presented with bilateral vision loss. A detailed ocular examination, fundus fluorescein angiography, abdominal ultra sound, cystoscopy, brain CT scan, and laboratory examinations were carried out. Physical examination was notable for a high blood pressure and the visual acuity was present in both eyes. Visual acuity was noted by hand movement and counting fingers at one meter distance in right eye and left eye respectively. Further examination revealed signs of intense headache, vomiting, irritability, and blood pressure of 220/130 mm of Hg. Fundoscopy showed bilateral arteriolar narrowing, retinal hemorrhages, cotton wool exudates, and bullous exudative retinal detachments. Fundus fluorescein angiography revealed macular ischemia and pinpoint leaks. His urinary bladder was distended and Cystoscopy discovered high bladder neck and bladder neck stenosis causing obstruction. Ultrasonography showed dilated ureters suggestive of obstructive uropathy causing chronic interstitial nephropathy and chronic renal failure stage III leading to hypertension. Treatment with antihypertensive therapy over the next four months resulted in improvement in systemic blood pressure and subsided retinal detachment. Subsequently, the high bladder neck obstruction was relieved by appropriate urologic intervention. Conclusion: This case report highlights the clinical presentation of accelerated hypertension with obstructive uropathy which is rare and the importance for ophthalmologists in first detecting the accelerated hypertension which led to successful recovery with treatment of antihypertensives.
延伸閱讀
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