A 73 y/o AAF presents to the ED with eye pain and headache for the past 12 hours. She states that she has been blind for the past 3 years, but has never had pain associated with her lack of vision. She reports a 10/10 headache which began gradually after she came home from hemodialysis earlier in the day. She denies nausea, vomiting, fever or neck stiffness. She describes her headache as global in nature.
PMHx: DM, HTN, ESRD, cataracts
PSHx: none
Meds: blood pressure and diabetes meds
Allergeries: NKDA
SocHx: lives with her daughter, denies ETOH, drugs or tobacco use
PE: BP 221/110, P 60, R 16, T 98.5, Pox 98% (RA)
GEN: WNWD, AAF, appears in pain, moaning
HEENT: Pupils difficult to visualize due to cataracts, EOMI intact, no scleral injection or icterus, lids lashes and lacrimals normal without evidence of infection, fluoresceine uptake negative, unable to visualize fundus, difficult to visualize anterior chamber clearly due to large cataracts, IOP normal. No temporal TTP, normal neck flexion
CHEST: CTA B, nonlabored
CV: RRR, no M/R/G
ABD: soft, NTND, +BS
Bedside ultrasound is performed to evaluate the retina and for ICP.
What do these images demonstrate?
Thanks to Dr. Ashley Doescher for the images in this case!
This is kinda of complicated by the fact that the patient is already blind.
ReplyDeleteBut.. Right Eye: There is hyperechoic areas inside the globe of the eye, possibly Vitreous Hemmorhage? Retinal Detatchment?
Left Eye: Appears normal? Maybe Lens calcification, hence cataracts.
Not sure if Retinal Detachment can cause 10/10 HA?
My best guess, Steve MacDade
Great pick up Steve! It it sometimes difficult to determine a vitreous hemorrhage from a retinal detachment as blood over time will layer out, but this patient has a vitreous hemorrhage and large bilateral cataracts. Great job!
ReplyDelete