Painless bilateral visual loss in a 33-year-old woman with severe arterial hypotension

Olaia Subirà, Silvia Muñoz, Juan José Sánchez, Paloma Puyalto, Andrew G. Lee

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    Abstract

    © 2017 Elsevier Inc. 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.
    Original languageEnglish
    Pages (from-to)125-131
    JournalSurvey of Ophthalmology
    Volume63
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2018

    Keywords

    • Takayasu arteritis
    • Takayasu retinopathy
    • hypotensive retinopathy
    • ischemic retinopathy
    • systemic hypotension

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