RETINAL VASCULAR IMPACT IN SYSTEMIC HYPERTENSION. CASE REPORT
We report a case of malignant systemic hypertension in the context of a multifactorial association (chronic kidney disease, hereditary thrombophilia, autoimmune thyroiditis, hyperaldosteronism, infectious optic neuritis) with ophthalmological onset symptoms only, highlighting the interrelationship between the retinal vascular impact and systemic hypertension, as well as between the systemic hypertension and the patient's underlying diseases. The paper presents the case of a 40-year-old female who complained of sudden loss of visual acuity in both eyes. The ophthalmological examination was suggestive for hypertensive neuroretinopathy, but the management of diagnosis and therapy was particularly difficult in the absence of systemic complaints and low patient compliance for a long time regarding the complementary interdisciplinary consultations that were recommended by the ophthalmologist. Confirmation of the diagnosis of hypertensive neuroretinopathy was possible only late in the evolution of the disease, with the appearance of systemic complications of hypertension such as: encephalopathy, cardiomyopathy, and nephropathy. In this context, a plurietiologic determinism was identified: chronic kidney disease, autoimmune thyroiditis, hyperaldosteronism, hereditary thrombophilia, and infectious optic neuritis. The ophthalmologic condition began to evolve favorably anatomically and functionally only after the establishment of pathogenic treatment. In conclusion, we are faced with a complex case that requires a multidisciplinary approach to assess a wide range of diseases, which analyzed separately, can have retinal vascular impact.
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