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Last additions - Hypertensive Retinopathy - Cotton Wool Spots and Elschnig Spots and Optic Disc Edema - Malignant Hypertension

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 281 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 220 viewsNerve Swelling is lessApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema (NFL Scan - Black Line this visit, Gray line 6 weeks ago)251 viewsNerve Swelling is LessApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 195 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 269 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 518 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1023 viewsElschnig SpotsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 738 viewsElschnig SpotsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 670 viewsElschnig Spots are pigment spots in peripheryApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 477 viewsElschnig Spots are pigment spots in peripheryApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 442 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 413 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 233 viewsMacular Scan Shows Cotton Wool Spots and Nerve Swelling (on Left)Apr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 299 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 259 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 426 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 457 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 696 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 701 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 615 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 859 viewsApr 25, 2013
     
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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.