Andreas94

Optometrist

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### Case Report

Follow up of the patient with Central Retinal Vein Occlusion. He was taken directly to hospital where my diagnosis was confirmed. A blood pressure of 270 over 160 was found. He was kept in intensive care for 3 days and observed for a few more days. If he hadn't come for a routine eye exam, he would probably suffer from a massive stroke within a day or two. This happened in rural Norway, far from the hospital.

A secondary diagnosis of glaucoma was also confirmed. He will get a new check with an ophthalmologist in about one month when BP is under control and stable.

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### Similar Cases

1. **Patient's Details:**  
   A male patient 55 years old, average body weight complaining recurrent attacks of sudden syncopes starting by dizziness and sweating that progressed rapidly to fainting.  
   - **Transferred to Hospital**  
     Blood pressure measured and found low, improved with saline solution.  
   - **Normal CBC**  
   - **Normal ECHO**  
   - **Normal CT brain and neurological examination**  
   - **Diagnosis:** Possible differential diagnosis to consider

2. **Patient's Details:**  
   Patient came in with severe thrombocytopenia of unknown origin.  
   - GCS 15 for 7-8 days.  
   - Day 7 had LP.  
   - Day 8: Slowly widening pulse pressures, sudden increased bleeding from LP site, then acute hypertension, change in LOC, dropped to GCS 3.  
   - **Diagnosis:** CT revealed this.

3. **Patient's Details:**  
   88 YO M called for unresponsive and vomiting.  
   - Past medical hx of CVA and currently on warfarin.  
   - Last seen normal around 1100-1130, called around 1300.  
   - Completely unresponsive to painful stimuli; last BP at the hospital read 263/139.  
   - **Action:** RSIed once at the hospital and taken to CT.  
   - **Plan:** Keep his pressure around 180 systolic to prevent cutting off complete blood supply to his brain, reverse the warfarin, and hope he stops bleeding.

4. **Patient's Details:**  
   Patient admitted to the hospital with leg edema and difficulty in breathing.  
   - **Question:** What’s your diagnosis? What necessary tests will you propose to get to the diagnosis?

5. **Patient's Details:**  
   A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.  
   - **History of:** Hypertension, long-term smoking, sedentary lifestyle.  
   - **Physical Examination:** Bibasilar crackles noted on lung auscultation.  
   - **Action:** ECG performed, promptly referred to the emergency department.

6. **Patient's Details:**  
   A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.  
   - **Exposure:** No recent travel or exposure to new environments.  
   - **Cares for:** Small kennel with dogs rescued from the streets.  
   - **Physical Examination:** Multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and left gluteal area.

7. **Patient's Details:**  
   A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.  
   - **Physical Examination:** Multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

8. **Patient's Details:**  
   Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family.  
   - **Question:** Are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?

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### Conclusion

- Eye exams are crucial in detecting otherwise hidden serious conditions that might lead to life-threatening outcomes.