Painless bilateral visual loss in a 33-year-old woman with severe arterial hypotension.
A 32-year-old woman experienced dizziness and headache for 5 months. She also complained of painless, progressive bilateral visual loss for several weeks. Before developing the initial symptoms, she had an uncomplicated pregnancy except for dizziness and systemic hypotension during the first term. Fundus examination disclosed prominent retinal arteries as well diffuse microaneurysms, widespread intraretinal hemorrhages, and hyperemic optic disks. Brain magnetic resonance imaging revealed multiple supratentorial white-matter lesions suggestive of ischemic strokes. Initially, she had severe systemic hypotension (41/17 mm Hg). When reassessed, blood pressure was normal in the lower limbs, but there was severe hypotension in the upper limbs. An angio-computed tomography of the supraortic trunks showed occlusion of both primitive carotid arteries, both subclavian arteries and the right axillary and humeral arteries. Based on these findings, the diagnosis of Takayasu type-I arteritis with ischemic retinopathy and cerebrovascular disease was established. Bilateral retinal panphotocoagulation and aorta to right carotid bypass were performed because of the severity of the ischemic lesions.
Department of Ophthalmology, Hospital Universitari de Bellvitge, Barcelona, Spain. Electronic address: olaiasubira@gmail.com.
Olaia
O
Subirà
Department of Ophthalmology, Hospital Universitari de Bellvitge, Barcelona, Spain.
Silvia
S
Muñoz
Department of Radiology, Hospital Universitari de Bellvitge, Barcelona, Spain; Department of Medicine, Facultat de Ciències de la Salut. Universitat Internacional de Catalunya, Barcelona, Spain.
Juan José
JJ
Sánchez
Department of Medicine, Facultat de Ciències de la Salut. Universitat Internacional de Catalunya, Barcelona, Spain.
Paloma
P
Puyalto
Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Department of Ophthalmology, Neurology and Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; Department of Ophthalmology, University of a Iowa Hospital and Clinics, Iowa City, Iowa, USA; Department of Ophthalmology, The UTMD Anderson Cancer Center, Houston, Texas, USA; Department of Ophthalmology, UTMB, Galveston, Texas, USA.
Andrew G
AG
Lee
D000328:Adult; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications*; D007511:Ischemia; D009901:Optic Nerve Diseases / Q000209:etiology*; D012164:Retinal Diseases / Q000209:etiology*; D013625:Takayasu Arteritis / Q000150:complications*
Takayasu arteritis; Takayasu retinopathy; hypotensive retinopathy; ischemic retinopathy; systemic hypotension