Madigan Army Medical Center, Emergency Medicine, Joint Base Lewis-McChord, Washington.
William Beaumont Army Medical Center, Ophthalmology, El Paso, Texas.
J Emerg Med. 2021 Feb;60(2):220-222. doi: 10.1016/j.jemermed.2020.09.033. Epub 2020 Oct 23.
Emergency physicians frequently evaluate patients with vision changes. The differential for this chief symptom is broad. We present a unique cause of a fixed scotoma that started while the patient was running sprints.
The patient described a bright central scotoma that later became a dark oblique line across her central vision. This painless defect moved predictably with eye movements. Ocular ultrasonography was performed and revealed a well-demarcated hyperechoic lesion in the posterior segment of the right eye. There was no similar lesion found in her left eye. In consultation with ophthalmology, the patient's history and examination were consistent with valsalva retinopathy. To our knowledge, this is only the second published case of valsalva retinopathy/premacular hemorrhage identified on ocular ultrasonography in emergency medicine literature. In this article, we further expand on management and provide correlating fundoscopic images. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians frequently evaluate patients with visual changes. Valsalva retinopathy is a rare cause of a visual scotoma that can be diagnosed through history and ultrasound. It often resolves over weeks to months without intervention. However, it does require urgent ophthalmologic evaluation to rule out peripheral retinal tears, which may require laser retinopexy or surgical management.
急诊医生经常评估有视力变化的患者。这个主要症状的鉴别诊断范围很广。我们提出了一个独特的固定暗点的原因，这个暗点是在患者短跑时开始出现的。
患者描述了一个明亮的中央暗点，后来变成了一条穿过她中央视力的暗斜线。这个无痛的缺陷可以随着眼球运动而预测地移动。进行了眼部超声检查，显示右眼后段有一个界限清楚的高回声病变。左眼没有发现类似的病变。在与眼科医生会诊后，根据患者的病史和检查结果，符合valsalva 视网膜病变。据我们所知，这是在急诊医学文献中仅有的第二例通过眼部超声检查发现的 valsalva 视网膜病变/黄斑前出血病例。在本文中，我们进一步扩展了管理内容，并提供了相关的眼底图像。
为什么急诊医生应该了解这个问题？急诊医生经常评估有视觉变化的患者。valsalva 视网膜病变是一种罕见的引起视觉暗点的原因，可以通过病史和超声检查来诊断。它通常在几周至几个月内无需干预即可自行消退。然而，确实需要紧急眼科评估以排除周边视网膜撕裂，这可能需要激光视网膜固定术或手术治疗。
