BMJ:恶性高血压所致的高血压性视网膜病变

2016-09-28 MedSci MedSci原创

非洲男性,25岁,因视力下降,头痛持续三小时而就诊。血压为228/132 mm Hg。最佳矫正视力右眼为20 / 80,左眼为20 /120(正常:20 / 20)。下图显示右眼眼底(图1)。根据病史和视网膜检查结果,诊断是什么?答案:恶性高血压所致的高血压性视网膜病变。双侧眼底检查显示,所有象限视网膜出血、棉絮状渗出点、视盘肿胀和硬性渗出,形成了一个“黄斑星”。这些表现说明是外层视网膜渗出,沿着

非洲男性,25岁,因视力下降,头痛持续三小时而就诊。血压为228/132 mm Hg。最佳矫正视力右眼为20 / 80,左眼为20 /120(正常:20 / 20)。下图显示右眼眼底(图1)。根据病史和视网膜检查结果,诊断是什么?



答案:恶性高血压所致的高血压性视网膜病变。

双侧眼底检查显示,所有象限视网膜出血、棉絮状渗出点、视盘肿胀和硬性渗出,形成了一个“黄斑星”。这些表现说明是外层视网膜渗出,沿着神经纤维表现出星状分布。

鉴别诊断包括放射性视网膜病变、贫血、血液病、眼缺血综合征,以及视网膜静脉阻塞。渗出和出血可能提示双侧视神经视网膜炎(特发性或传染性疾病,如猫抓病,莱姆病,或梅毒)。

急性期治疗包括全身应用β受体阻滞剂、硝酸盐、呋塞米和血液透析。治疗五个月期间,患者视网膜的变化在慢慢改善,在第六个月随访时,患者双眼的最佳矫正视力为30 / 20。

恶性高血压可导致眼闭塞性疾病,如缺血性视网膜病变、视神经病变、脉络膜病变,和不可逆转的视力丧失。适当治疗病变可以逆转,视力通常也会提高。高血压性视网膜病是恶性高血压的一个标志,是一种罕见的急症,可伴有肾脏、心脏或脑的缺血性损害,早期发现异常重要。

原始出处:


Inês Leal. A bilateral macular star and optic disc oedema. BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i4797.

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    2016-10-13 1e10c84am36(暂无匿称)

    文章真好,喜欢阅读

    0

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    2017-07-11 gaoxiaoe
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    2016-10-01 舒心和人

    高血压的治疗同样重要,感谢分享

    0

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    2016-09-30 zutt
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