Tanios Michel, Shaker Hayam, Mansi Ishak A
Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA.
J La State Med Soc. 2012 Mar-Apr;164(2):87-8, 90-1.
In this case, we report a 43-year-old African-American woman who presented with acute vision loss of the left eye. The patient was found to have central retinal artery occlusion (CRAO). Clinical examination showed characteristic physical findings of severe mitral stenosis. Echoardiographic findings confirmed the diagnosis. Laboratory testing was negative for hypercoagulability diseases. The patient suffered permanent vision loss in her left eye due to thromboembolic phenomenon secondary to mitral stenosis. Few case reports in literature, most of which date back to more than half a century ago, have reported CRAO secondary to embolic phenomenon due to mitral stenosis. The patient was born and had lived all of her life in the United States; she was admitted to hospitals on several occasions for delivery, cesarean section, and routine preventive healthcare. However, the distinctive physical examination findings were detected in none of her healthcare encounters, which would have prevented such a devastating complication of mitral stenosis. Rheumatic heart disease still exists in such a developed nation, and attentive and skilful physical examination during routine healthcare visits is important for optimum medical care.
在此病例中，我们报告了一名43岁的非裔美国女性，她因左眼急性视力丧失前来就诊。该患者被诊断为视网膜中央动脉阻塞（CRAO）。临床检查发现了严重二尖瓣狭窄的典型体征。超声心动图检查结果证实了诊断。实验室检查显示高凝性疾病为阴性。由于二尖瓣狭窄继发的血栓栓塞现象，该患者左眼遭受了永久性视力丧失。文献中很少有病例报告，其中大多数可追溯到半个多世纪以前，报道了二尖瓣狭窄继发栓塞现象导致的CRAO。该患者出生并一直生活在美国；她曾多次因分娩、剖宫产和常规预防性医疗保健入院。然而，在她所有的医疗就诊中均未发现独特的体格检查结果，而这些结果本可预防二尖瓣狭窄这种毁灭性并发症。在这样一个发达国家，风湿性心脏病仍然存在，在常规医疗就诊期间进行细致且熟练的体格检查对于优化医疗护理非常重要。
