Malignant Hypertension in a Youth - A Rare Case
Sunder (not the actual name) consulted me for his minor eye problem. He also complained of deterioration of vision in his left eye. When I examined him, he had already lost around 90% of his useful vision in the left eye and there was not much loss in the other eye. I thought that it was one of the diseases of the retina, so I arranged for the dilatation of the pupil, and examined him in detail. It is worthwhile to note here that Mr. Sunder quarrelled with the receptionist as well as with the doctor (me) for petty reasons. The result of the examination shocked me. I recognised the presence of plenty of haemorrhages and exudates all over the retina, especially in the macular area (central point of the retina). Usually one expects these findings in a man of 60 - 65 years. Immediately I ordered for blood and urine examinations, more important than that the Blood pressure recording. Mr. Sunder who was only 27 years was shocked and even protested with me about B.P. recording. Somehow I was able to convince him and sent him to a competent Physician for a detailed medical examination.
The senior Physician who examined Sunder was surprised and also shocked to record 220/ 130mm of hg, which normally should have been in the range of 120/ 80mm of hg. More than that he was astonished to know that Sunder was not having the symptoms of severe giddiness and headache. The physician immediately congratulated me for having already diagnosed the case as Malignant Hypertension (Abnormal increase of blood pressure), only by looking into the eyes without recording blood pressure.
Even though hypertension is a disease of the body, the effect of the disease is seen in the organs like eye and kidney. The blood pressure exerts pressure over the blood vessels, causes narrowing of blood vessels. In the stage of malignant hypertension, there would be plenty of haemorrhages (bleeding spots), and exudates (accumulation of fatty materials) all over the retina. If this accumulation is concentrated over the macula (the centre point of retina ), the vision deteriorates remarkably, as happened in the case of the left eye of Sunder.
In the case of Mr. Sunder, any delay in the diagnosis by 4-5 days would have caused serious problems not only to the other eye, but also to his life, as there was a possibility of getting an attack of brain haemorrhage. I feel that this is the importance of reporting this case. I am happy to inform that the vision of the affected left eye was improved remarkably by 60-65%, and his blood pressure was reduced to a healthy reading of 130/86 mm of hg. very soon.
Related Tags: malignant hypertension, hemorrhages, exudates, macula, brain hemorrhage
Dr.H.S.Mohan
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