Dead Things Don’t Swell

Nova Southeastern University, Davie, Florida, USA

Introduction. Elevated blood pressure can lead to malignant hypertension and is a significant risk factor for the development of retinal artery occlusions. New management guidelines indicate that patients with transient ischemic attacks, including transient monocular vision loss, and retinal artery occlusions should be urgently referred to a specialized stroke unit for proper assessment. Case presentation. A 50-year-old Haitian male patient with symptomatic dimming vision presented with malignant hypertension along with a branch retinal artery occlusion in the right and a suspected previous central retinal artery occlusion in the left eye, evidenced by a history of sudden, painless vision loss, an atrophic retina, attenuated sclerotic arterioles and optic nerve head pallor. Deviation From the Expected. Hypertension is a systemic condition. Here, we discuss a unilateral presentation of malignant hypertension secondary to a previous retinal artery occlusion leading to inner retinal cell death and necrosis. Discussion. Transient vision loss can occur secondary to retinal artery occlusions and is an established prodromal indicator of ischemic stroke. 10-15% of patients experiencing a TIA have a stroke inside 90 days, half of those transpire within 48 hrs. 24% of patients have shown acute ischemic strokes on MRI, while neurologic signs and symptoms were not present in 38% of those individuals. Conclusion. Patients with transient ischemic attacks and retinal artery occlusions need to be further investigated for a stroke with referral to a specialized stroke unit and a diffusion-weighted MRI. Grants. None