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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 282 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 221 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)252 viewsNerve Swelling is LessApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 197 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 275 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 521 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1028 viewsElschnig SpotsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 742 viewsElschnig SpotsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 673 viewsElschnig Spots are pigment spots in peripheryApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 478 viewsElschnig Spots are pigment spots in peripheryApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 444 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 415 views6 week fu - CWS are FadingApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 234 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 302 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 262 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 429 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 459 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 698 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 704 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 618 viewsApr 25, 2013
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 860 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.