[Bilateral acute retrobulbar space-occupying lesion within the scope of thrombolytic therapy in myocardial infarct--a case report].
A 51-year-old male patient with circulatory arrest and ventricular fibrillation was brought to the emergency department after restoration of spontaneous circulation. ECG presented signs of acute anterolateral myocardial infarction. Thrombolytic therapy according to the Neuhaus scheme was initiated. After administration of 60 mg rt-PA continuously increasing protrusion and hyposphagma of both eyes (left > right) and left-sided monocle-hematoma was observed. CCT showed shadowing of sinus ethmoidales frontales, broadening of the left lateral rectus muscle and retrobulbar volume increase without any signs of recent bleeding. The ophthalmologist had to answer the question if there was, in spite of the massive retrobulbar volume increase, a sufficient blood supply for both eyes. Ophthalmoscopically there were no signs of intraretinal bleeding or retinal ischemia. Intraocular circulation was checked by color Doppler sonography: Ophthalmic artery, the short posterior ciliary arteries and central retinal artery of both eyes showed very low, but definitely positive bloodflow. Further course showed a constant trend towards higher systolic bloodflow velocities in all eye vessels, verified by color Doppler sonography. Computer perimetry, performed after the recovery of the patient, revealed a visual field defect, which was related to a breakdown of the flow in a ciliary artery rather than to damage due to compression of the optic nerve. Possible reasons of the retrobulbar volume increase under thrombolytic therapy are discussed.
Vécsei
P V
PV
Klinik für Augenheilkunde, Universität Wien, Osterreich.
Domanovits
H
H
Kircher
K
K
Egger
S F
SF
Turetschek
K
K
D001783:Blood Flow Velocity / Q000187:drug effects; D005123:Eye / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D009408:Nerve Compression Syndromes / Q000139:chemically induced* / Q000000981:diagnostic imaging; D009901:Optic Nerve Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use; D017585:Ultrasonography, Doppler, Transcranial; D014792:Visual Acuity / Q000187:drug effects; D014794:Visual Fields / Q000187:drug effects
D010959:Tissue Plasminogen Activator