Neurology Main神经内科 1-10-课件.ppt

Hematology _ Oncology Main 1-10 Q 1A 65-yesr-old msn comes to the emergency department due to sudden-onset painless vision loss irt the right eye that began several hours ago. The patient says, IFlt was like a shade dropping over my eye. He had a similar episode 3 months ago that resolved spontaneously after several minutes. He has never seen flashing lights or floaters in his eyes. The patients medical history includes hypertension and hyperlipidemia. Temperature is 37.1 C (98.8 F), blood pressure is 150/90 mm Hg: pulse is 72/min and regular, and respirations are 14/min, Visual acuity is 20/20 on the left and 20/200 on the right. Funduscopy findings of the right eye are shown below.Which of the following is the most likely cause of this patients symptoms?A. Arterial embolic occlusion B. Malignant hypertension C. Retinal detachment D. Venous thrombotic occlusion E. Vitreous hemorrhage A 1Correct answer:AThis patient with acute painless monocular vision loss that persists for several nours likely has a central retinal artery occlusion (CRAO), which most commonly begins as an emtiolized plaque from the ipsllateral carotid artefy; a cardioembolic source eg due to atrial fibrillation? is also possible Most patients develop significant permanent visual deficits Funduscopy can reveal a whitened retina (due to edema) and. fin the macula, the central fovea appears red from underlying choroid (cherry red spot).Patients usually have a defect in the afferent pupil reflex.CRAO rs an ophthalmologic emergency, and attempts at recovering vision (eg. anterior chamber paracentesis, ocular massage, revascularization) shoufd be considered.Workup aiso incEudes noninvasive imaging of the carotids to evafu^te for stenosis. AttieroscErotic treatment (eg, aspirin, statin) and, in cases of cardioembolic phenomenon, long-tenn anticoagulation (eg, warfarin) are often initiated,(Choice B) Patients with hypertensive retinopathy typically do not have acute vision loss. On funduscopy. there is fo