DR.ANN RESHMA RAJAN

DR. ANTHRAYOS C.V. KAKKANATT, DR. SREELAKSHMI ARUN, DR. RAKENDU PUTHIYEDATH

Abstract

25 year old female, no known co-morbidities, presents with headache of 1 month duration, 1 episode of generalised tonic clonic seizure and blurring of vision since 1 day. Patient in altered sensorium, accelerated hypertension (200/120 mm Hg). Other points in general examination normal. Ophthalmic examination showed a visual acuity of 6/18p with PH 6/9p in right eye, 6/26 with PH 6/18p in left eye. Anterior segment examination and IOP was normal. Fundus showed grade 4 hypertensive retinopathy with papilloedema with macular edema. USG abdomen showed CKD(undetected till date), blood investigations revealed acute on CKD, ANA profile-borderline PCNA positivity. Brain imaging showed posterior reversible encephalopathy syndrome(PRES)with acute parieto-occipital infarcts and hemorrhagic components, ECHO consistent with untreated systemic hypertension. Patient managed conservatively and hemodialysis given. Follow up evaluation showed bilateral discs going into optic atrophy.