Clinical reasoning / blindness / erythrocytosis

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


[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]

--------------------------------------------------------------------------------


Who loves ya.
Tom
Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore!
http://pages.ivillage.com/ironjustice/manisaherbivore
DEAD PEOPLE WALKING
http://pages.ivillage.com/ironjustice/deadpeoplewalking