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  #1  
Old 04-17-2012
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Eye Unilateral Painful Eye with Sudden Visual Loss!

A 62 year old female recent immigrant from Central Africa with sudden visual loss in the left eye. The left eye and left periorbital area have been painful for the past 5 days. Funduscopic examination of the left eye reveals multiple cotton wool spots in the peripapillary area. The visual acuity is 20/200. The right eye appears normal, with normal vision. Duplex ultrasonography of the carotid arteries shows total occlusion of the left internal carotid artery. Fluorescein angiography of the fundus reveals focal hyperfluorescence with delayed arteriovenous transit time in the left eye.Which of the following is the most likely at this point in the evaluation?
  • A Hypertensive retinopathy
  • B Diabetic eye disease
  • C Human immunodeficiency virus (HIV) associated retinopathy
  • D Retinal involvement of systemic autoimmune disease
  • E Ocular ischemic syndrome
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Old 04-17-2012
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Answer is E
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Old 04-17-2012
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I am glad this question popped out in here!

I had something similar somewhere (not in UW) and I got it wrong last time.

I think it has to be diabetic thing... (cotton wool spots... It is either associated with db or... or I am picking it wrong again...)

B)
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Old 04-17-2012
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nice question, learning new things in each one of your questions!

hmm.. Didn't know what cotton wool spots are so I HAD to look it up ... here's what I found:

Quote:
"Cotton wool spots are an abnormal finding on funduscopic exam of the retina of the eye. They appear as fluffy white patches on the retina. They are caused by damage to nerve fibers and are a result of accumulations of axoplasmic material within the nerve fiber layer.

Diabetes and hypertension are the two most common diseases that cause these spots, and the best treatment would be to treat the underlying disease. In diabetes they are one of the hallmarks of pre-proliferative retinopathy. More rarely, HIV and pancreatitis (Purtscher) retinopathy can also lead to the appearance of cotton wool spots."
Source: http://en.wikipedia.org/wiki/Cotton_wool_spots
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Old 04-17-2012
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Quote:
Originally Posted by DocSikorski View Post
I am glad this question popped out in here!

I had something similar somewhere (not in UW) and I got it wrong last time.

I think it has to be diabetic thing... (cotton wool spots... It is either associated with db or... or I am picking it wrong again...)

B)
Think again harder but keep it simple.
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Old 04-17-2012
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hypertensive retinopathy......
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Quote:
Originally Posted by Desos View Post
Think again harder but keep it simple.
diabetic EYE disease... I am a very lazy reader... wool spots and sorbitol are not the same haha. Tricky-picky nice question!
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Old 04-17-2012
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Correct Answer

Correct answer is E.... key " unilateral + sudden onset of visual loss"

A, B, C, D will cause bilateral and progressive visual impairment
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Default E....

Here is the info to support the answer

Ocular ischemic syndrome (OIS) encompasses the ocular signs and symptoms that result from chronic vascular insufficiency. The presenting symptoms include ocular pain and abrupt or gradual visual loss

The most common etiology of OIS is severe unilateral or bilateral atherosclerotic disease of the internal carotid artery or marked stenosis at the bifurcation of the common carotid artery. OIS may also be caused by giant cell arteritis.High-grade carotid stenosis-Stenosis of the carotid artery results in concomitant chronic ophthalmic artery insufficiency.

Symptoms can include amaurosis fugax, gradual or sudden visual loss, and pain. Loss of visual acuity is the most frequently encountered symptom, present in 70-90% of patients at the time of presentation. Pain: About 40% of patients with OIS will present with symptoms of pain. The pain is characteristically described as a dull ache over the brow, which begins gradually over a period of hours to days.

DD- CRVO, Gaint cell arteritis, diabetic retinopathy...
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Old 04-18-2012
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Default As I remember

Cotton wool spots, microaneurisms>> diabetic retinopathy

Vascular narrowing, Silver wiring >> hypertensive retinopathy
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Quote:
Originally Posted by Desos View Post
Correct answer is E.... key " unilateral + sudden onset of visual loss"

A, B, C, D will cause bilateral and progressive visual impairment
Unilateral !! Is the buzz word s*** missed it .
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Old 04-18-2012
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Quote:
Originally Posted by Rookie View Post
Unilateral !! Is the buzz word s*** missed it .
I don't think you missed the buzz word so much as fell for the distractor. I think one needs to keep in mind that incidental findings can always be present, and focus on the cause of the Sx.
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Old 04-18-2012
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Default anyone ?

delayed arteriovenous transit time in the left eye ???
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