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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 859 x angesehen00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 616 x angesehen00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 701 x angesehen00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 696 x angesehen00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 458 x angesehen00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 427 x angesehen00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 260 x angesehen00000
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htnretinopathy_gadi_032013_10.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 300 x angesehen00000
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htnretinopathy_gadi_032013_11.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 233 x angesehenMacular 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 414 x angesehen6 week fu - CWS are Fading00000
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htnretinopathy_gadi_042213_13.png
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 443 x angesehen6 week fu - CWS are Fading00000
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htnretinopathy_gadi_042213_14.png
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 477 x angesehenElschnig Spots are pigment spots in periphery00000
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htnretinopathy_gadi_042213_15.png
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 672 x angesehenElschnig Spots are pigment spots in periphery00000
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htnretinopathy_gadi_042213_16.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 741 x angesehenElschnig Spots00000
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htnretinopathy_gadi_042213_18.png
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1026 x angesehenElschnig Spots00000
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htnretinopathy_gadi_042213_19.png
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 520 x angesehen6 week fu - CWS are Fading00000
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htnretinopathy_gadi_042213_20.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 274 x angesehen6 week fu - CWS are Fading00000
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htnretinopathy_gadi_042213_21.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 195 x angesehen6 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)251 x angesehenNerve Swelling is Less00000
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htnretinopathy_gadi_042213_23.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 220 x angesehenNerve Swelling is less00000
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htnretinopathy_gadi_042213_24.jpg
Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 281 x angesehen6 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.