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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 Spotsvu 498 fois54-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
(0 votes)
cwshiv_pali02.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 358 fois54-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
(0 votes)
cwshiv_pali03.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 246 fois54-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
(0 votes)
cwshiv_pali04.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 221 fois54-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
(0 votes)
cwshiv_pali05.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 311 fois54-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
(0 votes)
cwshiv_pali06.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 193 fois54-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
(0 votes)
cwshiv_pali07.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 148 fois54-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
(0 votes)
cwshiv_pali08.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 122 fois54-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
(0 votes)
cwshiv_pali09.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 88 fois54-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
(0 votes)
cwshiv_pali10.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 133 fois54-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
(0 votes)
cwshiv_pali11.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 115 fois54-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
(0 votes)
cwshiv_pali12.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 86 fois54-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
(0 votes)
cwshiv_pali13.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 116 fois54-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
(0 votes)
cwshiv_pali14.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 119 fois54-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
(0 votes)
cwshiv_pali15.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 163 fois54-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
(0 votes)
cwshiv_pali16.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 154 fois54-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
(0 votes)
cwshiv_pali18.jpg
AIDS - HIV Retinopathy - Cotton Wool Spotsvu 212 fois54-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
(0 votes)
     
17 photos sur 1 page(s)

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.