Clinical reasoning / blindness / erythrocytosis

Discussion in 'Optometry Archives' started by ironjustice, Mar 5, 2005.

  1. ironjustice

    ironjustice Guest

    Ned Tijdschr Geneeskd. 2005 Jan 15;149(3):125-31. Related Articles,

    [Clinical reasoning and decision-making in practice. A 31-year-old
    woman with transient monocular blindness and polycythaemia]

    [Article in Dutch]

    Houwerzijl EJ, van Haelst PL, van Doormaal JJ, Gans RO.

    Afd. Interne Geneeskunde, Academisch Ziekenhuis Groningen, Postbus
    30.001, 9700 RB Groningen.

    A 31-year-old woman presented with recurrent transient monocular
    blindness. As transient ischaemic attacks were suspected further
    investigations were targeted at evaluation of premature atherosclerotic
    lesions in the internal carotid artery. Initially laboratory tests were
    not performed. After referral to a cardiovascular-disease prevention
    outpatient clinic, laboratory evaluation disclosed a marked isolated
    polycythaemia that turned out to be secondary to right-left shunting
    through multiple pulmonary arteriovenous malformations. The ultimate
    diagnosis was hereditary haemorrhagic telangiectasia. Later on,
    physical signs such as telangiectasia and central cyanosis were
    noticed. In the clinical decision-making process, laboratory tests
    associated with causes of transient monocular visual loss were not
    carried out and therefore clues important for the ultimate diagnosis
    were not obtained. In only a minority of young patients with transient
    monocular visual loss can this be ascribed to premature
    atherosclerosis. For these reasons, a proper physical examination and
    laboratory tests directed towards other causes must be part of the
    initial diagnostic work-up in young patients with visual disturbances
    and suspected transient ischaemic attacks.

    Publication Types:
    Case Reports

    PMID: 15693587 [PubMed - indexed for MEDLINE]


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    ironjustice, Mar 5, 2005
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