A 62-year-old man with a history of inadequate medical follow-up visits visits the office because he is having vision problems. For the past two weeks, his eyesight has been fuzzy. He witnessed a shadow appear abruptly over his right eye's visual field a day ago. The patient hasn't recently had headaches, nausea, dizziness, double vision, or vertigo. Examined pupils exhibit identical reactivity to light. Confrontational visual field testing demonstrates spotty vision loss. On funduscopic examination, as seen in the image below, a flame-shaped retinal hemorrhage is discovered in the right eye. Which of the following is the most likely cause of his visual disturbance?

Question

A 62-year-old man with a history of inadequate medical follow-up visits visits the office because he is having vision problems. For the past two weeks, his eyesight has been fuzzy. He witnessed a shadow appear abruptly over his right eye's visual field a day ago. The patient hasn't recently had headaches, nausea, dizziness, double vision, or vertigo. Examined pupils exhibit identical reactivity to light. Confrontational visual field testing demonstrates spotty vision loss. On funduscopic examination, as seen in the image below, a flame-shaped retinal hemorrhage is discovered in the right eye.  Which of the following is the most likely cause of his visual disturbance?

Quizplus · Accepted Answer

Eductional Objective: Severe hypertension in retinal precapillary arterioles causes endothelial disruption, leakage of plasma into the arteriolar wall, and fibrinous necrosis.  The necrotic vessels can then bleed into the nerve fiber layer, which can be seen on examination as dot- or flame-shaped hemorrhages.

A 62-Year-Old Man with a History of Inadequate Medical Follow-Up