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56-year-old man was seen in the office on March 11, 2013. He was hospitalized for five days a few weeks ago for increased high blood pressure. He said when he was hospitalized he is not sure, but his systolic blood pressure was in the high 200s and the diastolic pressure was in the mid 100s. His vision is reasonable in both eyes. He is not noticing any pain or discomfort. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: 9 OU. SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There are 2+ cotton wool spots on the macula. OS: Vertical C/D ratio is 0.1. There is 1+ optic nerve edema and 2+ cotton wool spots. SPECTRALIS-SD-OCT SCAN: The nerve fiber layer scan shows thickening of the nerve fiber layer in both eyes. The average thickness in the right eye is 109 microns with thickening of the superior and inferior pole. The left eye has 133 microns with thinning of the superior, but thickening of the inferior pole of the nerve. COLOR PHOTOS: The photos show the cotton wool spots in the macula of both eyes. IMPRESSION: 1. HYPERTENSIVE RETINOPATHY – BOTH EYES WITH COTTON WOOL SPOTS AND OPTIC NERVE EDEMA DISCUSSION: I explained to the patient that he does have manifestations of hypertensive retinopathy in both eyes. Generally when the blood pressure is controlled, the retina normalizes, but he may end up with a little bit of optic atrophy depending on how severe the ischemic insult to the eye was. I asked him to return for a check in six weeks so I can repeat some of the testing.

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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 821 εμφανίσεις00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 566 εμφανίσεις00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 650 εμφανίσεις00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 641 εμφανίσεις00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 425 εμφανίσεις00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 394 εμφανίσεις00000
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htnretinopathy_gadi_032013_09.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 238 εμφανίσεις00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 282 εμφανίσεις00000
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htnretinopathy_gadi_032013_11.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 206 εμφανίσειςMacular Scan Shows Cotton Wool Spots and Nerve Swelling (on Left)00000
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htnretinopathy_gadi_042213_12.png
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 383 εμφανίσεις6 week fu - CWS are Fading00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 409 εμφανίσεις6 week fu - CWS are Fading00000
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htnretinopathy_gadi_042213_14.png
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 436 εμφανίσειςElschnig Spots are pigment spots in periphery00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 626 εμφανίσειςElschnig Spots are pigment spots in periphery00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 664 εμφανίσειςElschnig Spots00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 967 εμφανίσειςElschnig Spots00000
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htnretinopathy_gadi_042213_19.png
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 475 εμφανίσεις6 week fu - CWS are Fading00000
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htnretinopathy_gadi_042213_20.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 234 εμφανίσεις6 week fu - CWS are Fading00000
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htnretinopathy_gadi_042213_21.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 179 εμφανίσεις6 week fu - CWS are Fading00000
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htnretinopathy_gadi_042213_22.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema (NFL Scan - Black Line this visit, Gray line 6 weeks ago)230 εμφανίσειςNerve Swelling is Less00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 200 εμφανίσειςNerve Swelling is less00000
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htnretinopathy_gadi_042213_24.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 262 εμφανίσεις6 week fu - CWS are Fading00000
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56-year-old man was seen in the office on March 11, 2013. He was hospitalized for five days a few weeks ago for increased high blood pressure. He said when he was hospitalized he is not sure, but his systolic blood pressure was in the high 200s and the diastolic pressure was in the mid 100s. His vision is reasonable in both eyes. He is not noticing any pain or discomfort. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: 9 OU. SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There are 2+ cotton wool spots on the macula. OS: Vertical C/D ratio is 0.1. There is 1+ optic nerve edema and 2+ cotton wool spots. SPECTRALIS-SD-OCT SCAN: The nerve fiber layer scan shows thickening of the nerve fiber layer in both eyes. The average thickness in the right eye is 109 microns with thickening of the superior and inferior pole. The left eye has 133 microns with thinning of the superior, but thickening of the inferior pole of the nerve. COLOR PHOTOS: The photos show the cotton wool spots in the macula of both eyes. IMPRESSION: 1. HYPERTENSIVE RETINOPATHY – BOTH EYES WITH COTTON WOOL SPOTS AND OPTIC NERVE EDEMA DISCUSSION: I explained to the patient that he does have manifestations of hypertensive retinopathy in both eyes. Generally when the blood pressure is controlled, the retina normalizes, but he may end up with a little bit of optic atrophy depending on how severe the ischemic insult to the eye was. I asked him to return for a check in six weeks so I can repeat some of the testing.