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59-year-old man was seen in the office on August 11, 2011. He was doing fine until Tuesday, which is two days ago when he developed a change in vision for about thirty minutes. He noticed he lost vision on the right side. He saw sort of shimmery kaleidoscope type vision change there and then that went away and his vision came all the way back to normal. He didn’t have any focal neurological changes and he didn’t have any specific headache. He has no history of any similar problems. He has no history of migraine nor does he have any history of intermittent neurological issues. He is currently under treatment for difficult to control blood pressure and his blood pressure medicines have been shuffled frequently and his blood pressure is pretty good lately. You saw a funny looking vessel in the back of his retina and suggest he come here for an evaluation. VISUAL ACUITY: OD 20/25, OS 20/25. IOP: 10 OU. Color vision is normal. SLIT EXAMINATION: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is no posterior vitreous separation on the inferior pole of the optic nerve. There is a retinal vein, which wraps around a retinal artery and is telangiectatic and looks like a venous, venous collateral from a compensated branch retinal artery occlusion. OS: Vertical C/D ratio is 0.5. There is no posterior vitreous separation. Just superonasal to the optic nerve there is a retinal artery that is tortuous and telangiectatic and turns in on itself several times in two different places before ultimately becoming normal again in the periphery. He does not appear to have any arterial venous anastomosis within it. There is no evidence of any capillary growths or tumors in the area nor is there any evidence of leakage in that area. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography confirms that the lesion in the left eye isn’t a retinal artery and I did not see any signs of retinal venous anastomosis within the lesion, it does appear to leak in the late frames. The right vessel, which is telangiectatic isn’t associated with a vein and doesn’t show any sign of current obstructions. IMPRESSION: 1. TORTUOUS RETINAL ARTERY – LEFT EYE 2. POSSIBLE GROUP 2 WYBURN-MASON SYNDROME 3. POSSIBLE ACEPHALIC MIGRAINES 4. RULE OUT ANY SORT OF CENTRAL NERVOUS SYSTEM LESION, ESPECIALLY LOOKING FOR POSSIBLE VASCULAR MALFORMATIONS ON THE LEFT SIDE DISCUSSION: I explained to the patient that the retinal artery in the left eye doesn’t look like anything that poses a threat to his vision or too his eye, but it may be indicative of a systemic problem, he does need to have an MRI scan to rule out any central nervous system lesions, especially given the visual symptoms, which would localize to the left side of his cerebral cortex. I have scheduled him for an MRI scan of the head and orbit. In the meantime I suggested he stop his aspirin till the MRI scans results are back and I asked him to see you back periodically. He is having headaches intermittingly. (MRI was normal)

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Anomalous Branch Retinal Artery 201 views59-year-old man OD 20/25, OS 20/25. TORTUOUS RETINAL ARTERY – LEF EYE
(POSSIBLE GROUP 2 WYBURN-MASON SYNDROME
POSSIBLE ACEPHALIC MIGRAINES )
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Anomalous Branch Retinal Artery 194 views59-year-old man OD 20/25, OS 20/25. TORTUOUS RETINAL ARTERY – LEF EYE
(POSSIBLE GROUP 2 WYBURN-MASON SYNDROME
POSSIBLE ACEPHALIC MIGRAINES )
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Anomalous Branch Retinal Artery 327 views59-year-old man OD 20/25, OS 20/25. TORTUOUS RETINAL ARTERY – LEF EYE
(POSSIBLE GROUP 2 WYBURN-MASON SYNDROME
POSSIBLE ACEPHALIC MIGRAINES )
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Anomalous Branch Retinal Artery 196 views59-year-old man OD 20/25, OS 20/25. TORTUOUS RETINAL ARTERY – LEF EYE
(POSSIBLE GROUP 2 WYBURN-MASON SYNDROME
POSSIBLE ACEPHALIC MIGRAINES )
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Anomalous Branch Retinal Artery 242 views59-year-old man OD 20/25, OS 20/25. TORTUOUS RETINAL ARTERY – LEF EYE
(POSSIBLE GROUP 2 WYBURN-MASON SYNDROME
POSSIBLE ACEPHALIC MIGRAINES )
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Anomalous Branch Retinal Artery 186 views59-year-old man OD 20/25, OS 20/25. TORTUOUS RETINAL ARTERY – LEF EYE
(POSSIBLE GROUP 2 WYBURN-MASON SYNDROME
POSSIBLE ACEPHALIC MIGRAINES )
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Anomalous Branch Retinal Artery 237 views59-year-old man OD 20/25, OS 20/25. TORTUOUS RETINAL ARTERY – LEF EYE
(POSSIBLE GROUP 2 WYBURN-MASON SYNDROME
POSSIBLE ACEPHALIC MIGRAINES )
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59-year-old man was seen in the office on August 11, 2011. He was doing fine until Tuesday, which is two days ago when he developed a change in vision for about thirty minutes. He noticed he lost vision on the right side. He saw sort of shimmery kaleidoscope type vision change there and then that went away and his vision came all the way back to normal. He didn’t have any focal neurological changes and he didn’t have any specific headache. He has no history of any similar problems. He has no history of migraine nor does he have any history of intermittent neurological issues. He is currently under treatment for difficult to control blood pressure and his blood pressure medicines have been shuffled frequently and his blood pressure is pretty good lately. You saw a funny looking vessel in the back of his retina and suggest he come here for an evaluation. VISUAL ACUITY: OD 20/25, OS 20/25. IOP: 10 OU. Color vision is normal. SLIT EXAMINATION: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is no posterior vitreous separation on the inferior pole of the optic nerve. There is a retinal vein, which wraps around a retinal artery and is telangiectatic and looks like a venous, venous collateral from a compensated branch retinal artery occlusion. OS: Vertical C/D ratio is 0.5. There is no posterior vitreous separation. Just superonasal to the optic nerve there is a retinal artery that is tortuous and telangiectatic and turns in on itself several times in two different places before ultimately becoming normal again in the periphery. He does not appear to have any arterial venous anastomosis within it. There is no evidence of any capillary growths or tumors in the area nor is there any evidence of leakage in that area. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography confirms that the lesion in the left eye isn’t a retinal artery and I did not see any signs of retinal venous anastomosis within the lesion, it does appear to leak in the late frames. The right vessel, which is telangiectatic isn’t associated with a vein and doesn’t show any sign of current obstructions. IMPRESSION: 1. TORTUOUS RETINAL ARTERY – LEFT EYE 2. POSSIBLE GROUP 2 WYBURN-MASON SYNDROME 3. POSSIBLE ACEPHALIC MIGRAINES 4. RULE OUT ANY SORT OF CENTRAL NERVOUS SYSTEM LESION, ESPECIALLY LOOKING FOR POSSIBLE VASCULAR MALFORMATIONS ON THE LEFT SIDE DISCUSSION: I explained to the patient that the retinal artery in the left eye doesn’t look like anything that poses a threat to his vision or too his eye, but it may be indicative of a systemic problem, he does need to have an MRI scan to rule out any central nervous system lesions, especially given the visual symptoms, which would localize to the left side of his cerebral cortex. I have scheduled him for an MRI scan of the head and orbit. In the meantime I suggested he stop his aspirin till the MRI scans results are back and I asked him to see you back periodically. He is having headaches intermittingly. (MRI was normal)