Deutsche medizinische Wochenschrift (1946) · 2011
[Retinal microangiopathy in arterial hypertension as an early marker of a cerebral macroangiopathy].
Клинический случайАннотация на английскомСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Michelson G, Engelhorn T, Dörfler A
Аннотация
HISTORY AND ADMISSION FINDINGS: A 54-year-old man reported having had nonspecific attacks of dizziness. His BMI was 27.7. Since 11 years he had been treated for arterial hypertension and had received oral medication for type 2 diabetes for one year. The latest blood pressure value was 134/109 mm Hg during treatment with a combination of atenolol, chlortalidone und hydralazine-HCl; furthermore hr received simvastatin, metformin, glimepirid und ramipril. A standardized telemedical imaging of the retina ("talkingeyes (®) ") was undertaken, revealing focal and generalized arteriolar narrowing of the retinal vessels and a retinal microinfarction (cotton wool spot) in the right eye. The arterial/venous ratio was decreased to 0.74 in the right and 0.77 in the left eye.
INVESTIGATIONS: Optical coherence tomographie (OCT) revealed an ischemic microinfarction of the retina with marked axonal swelling. The digital subtraction angiography of the cerebral vessels revealed a 40 % stenosis of the right internal carotid artery and a proximal, highgrade stenosis of the basilary artery.
TREATMENT AND COURSE: Angioplasty with stent insertion of the basilary artery was performed. Long-term observation showed no restenosis and a reduction in the size of the the retinal microinfarct.
CONCLUSION: Retinal microinfarctions denote localized retinal areas of hypoxia and underperfusion. They may act as markers of a generalized micro- and macroangiopathy. Patients with severe retinal microangiopathic changes should be examined thoroughly to detect early macroangiopathic changes. These can be treated by interventional procedures thus avoiding irreversible end-organ damages.
INVESTIGATIONS: Optical coherence tomographie (OCT) revealed an ischemic microinfarction of the retina with marked axonal swelling. The digital subtraction angiography of the cerebral vessels revealed a 40 % stenosis of the right internal carotid artery and a proximal, highgrade stenosis of the basilary artery.
TREATMENT AND COURSE: Angioplasty with stent insertion of the basilary artery was performed. Long-term observation showed no restenosis and a reduction in the size of the the retinal microinfarct.
CONCLUSION: Retinal microinfarctions denote localized retinal areas of hypoxia and underperfusion. They may act as markers of a generalized micro- and macroangiopathy. Patients with severe retinal microangiopathic changes should be examined thoroughly to detect early macroangiopathic changes. These can be treated by interventional procedures thus avoiding irreversible end-organ damages.