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54-year-old woman was seen in the office on 3/25/2011. She was diagnosed as HIV positive in 1993. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia back in November of 2010. Earlier this month, on March 3rd, she had an episode where she felt strange. She dropped a smoothie and had slurred speech for about ten minutes. Her symptoms completely cleared and it was thought she had a transient ischemic attack. Since then she has had MRI and CT scans, both of which were normal, but she has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VISUAL ACUITY: Her vision is 20/25 in each eye. IOP: OD 11, OS 12. SLIT LAMP EXAM: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is no posterior vitreous separation. There are cotton-wool spots predominantly superior to the optic nerve and nasally. OS: Vertical C/D ratio is 0.5. There is no posterior vitreous separation. There are cotton-wool spots in the inferotemporal periphery. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows some telangiectasis of the retinal capillaries. There is no evidence of any retinal vascular occlusions. IMPRESSION: 1. HIV RETINOPATHY WITH COTTON-WOOL SPOTS – BOTH EYES 2. HISTORY OF TRANSIENT ISCHEMIC ATTACK 3. POSSIBLE CENTRAL NERVOUS SYSTEM VISUAL FIELD LOSS DISCUSSION: I explained to the patient she does have HIV retinopathy, which is not uncommon in patients with AIDS, especially for this duration. The cotton-wool spots are probably from immune complexes or a sign of microvascular disease. Most patients with this though do not have visual symptoms, and since the onset of the visual symptoms coincide with the time she had the transient ischemic attack, I think it is likely she may have had some sort of central nervous system issue that has caused her to have some changes in her peripheral visual field. I would appreciate it if you could obtain visual field testing.

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AIDS - HIV Retinopathy - Cotton Wool Spots429 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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AIDS - HIV Retinopathy - Cotton Wool Spots305 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali03.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots201 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali04.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots181 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali05.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots269 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali06.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots165 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali07.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots122 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali08.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots87 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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AIDS - HIV Retinopathy - Cotton Wool Spots68 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali10.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots104 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali11.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots95 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali12.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots64 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali13.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots93 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali14.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots89 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali15.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots130 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali16.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots128 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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cwshiv_pali18.jpg
AIDS - HIV Retinopathy - Cotton Wool Spots175 views54-year-old woman HIV positive for 18 years. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia 5 months ago. She has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VA 20/25 in both eyes. 00000
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54-year-old woman was seen in the office on 3/25/2011. She was diagnosed as HIV positive in 1993. Her CD4 count is currently less than 50 and she was hospitalized for pneumocystis carinii pneumonia back in November of 2010. Earlier this month, on March 3rd, she had an episode where she felt strange. She dropped a smoothie and had slurred speech for about ten minutes. Her symptoms completely cleared and it was thought she had a transient ischemic attack. Since then she has had MRI and CT scans, both of which were normal, but she has noticed just for the last few weeks a few blind spots in the paracentral vision. Predominantly out of her right eye when she closes her left eye, she sees a few temporal blind spots. VISUAL ACUITY: Her vision is 20/25 in each eye. IOP: OD 11, OS 12. SLIT LAMP EXAM: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is no posterior vitreous separation. There are cotton-wool spots predominantly superior to the optic nerve and nasally. OS: Vertical C/D ratio is 0.5. There is no posterior vitreous separation. There are cotton-wool spots in the inferotemporal periphery. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows some telangiectasis of the retinal capillaries. There is no evidence of any retinal vascular occlusions. IMPRESSION: 1. HIV RETINOPATHY WITH COTTON-WOOL SPOTS – BOTH EYES 2. HISTORY OF TRANSIENT ISCHEMIC ATTACK 3. POSSIBLE CENTRAL NERVOUS SYSTEM VISUAL FIELD LOSS DISCUSSION: I explained to the patient she does have HIV retinopathy, which is not uncommon in patients with AIDS, especially for this duration. The cotton-wool spots are probably from immune complexes or a sign of microvascular disease. Most patients with this though do not have visual symptoms, and since the onset of the visual symptoms coincide with the time she had the transient ischemic attack, I think it is likely she may have had some sort of central nervous system issue that has caused her to have some changes in her peripheral visual field. I would appreciate it if you could obtain visual field testing.