malignant hypertensive retinopathy
Introduction
Introduction to malignant hypertensive retinopathy Malignant hypertensive retinopathy is a sudden sudden increase in blood pressure, causing retinal and choroidal vascular decompensation, retinal blood vessels are significantly narrowed, retinal edema is widespread, multiple flaky hemorrhage and large cotton lint and optic disc edema can be seen in the fundus. . basic knowledge Sickness ratio: 0.0004%-0.0009% Susceptible people: no special people Mode of infection: non-infectious Complications: Osteoporosis, convulsions and convulsions, diabetic retinopathy
Cause
Causes of malignant hypertensive retinopathy
(1) Causes of the disease
Associated with adrenal hyperfunction.
(two) pathogenesis
The choroidal blood vessels are more vulnerable than the retinal blood vessels. When the blood pressure rises sharply, the regulation of the choroidal autonomic nervous system is impaired, and the choroidal arterioles and capillaries lose their ability to regulate. The choroidal capillaries themselves have many micropores, and the blood pressure rises rapidly. Increased its permeability, serous fluid and fibrin exuded into the choroidal stroma, retinal pigment epithelium and subretinal, fibrinoid necrosis of the choroidal arterioles wall, capillary occlusion, fibrin and platelets in the lumen, retina Diffuse leakage of pigment epithelium (Elschnig plaque), swelling of the whole body and fundus arterioles, staining, nucleus fragmentation, support for fiber swelling, proliferation, especially elastic fibers, typical changes to localized arteriolar fibrinoid necrosis , affecting the entire arterial wall, resulting in increased vascular permeability.
The retinal artery also showed fibrin-like necrosis, especially the small arteries and anterior capillaries located around the optic disc. The vascular barrier was damaged, the serous exudation caused retinal edema, and the formation of exudation caused bleeding and exudation. In areas where cotton-like plaques are present, ischemia is caused by small arteries and capillary occlusion, where axoplasmic transport is blocked, nerve fibers are swollen, organelles proliferate, late axonal ruptures, and cystoid bodies form. , that is, cotton plaques seen in clinical practice.
Prevention
Malignant hypertensive retinopathy prevention
Pay attention to the control of blood pressure and deal with emergencies in a timely manner.
Complication
Complications of malignant hypertensive retinopathy Complications Osteoporosis convulsions and convulsions Diabetic retinopathy
Heart, brain, kidney and other complications can be an important cause of death.
Symptom
Malignant hypertensive retinopathy symptoms common symptoms retinal edema clinic hypertension blind spot coma retinal hemorrhage hypotension proteinuria convulsions increased intracranial pressure nausea
This disease often has other organs of the body such as heart, brain, kidney damage, headache, nausea, vomiting, convulsions, coma and proteinuria, endocrine diseases are often accompanied by endocrine disorders of the whole body signs, such as Cushing synthesis The sign can be accompanied by facial and neck and chest and abdomen obesity, skin thin and facial purple, abdominal purple spots, diabetes, osteoporosis and excessive hair and gonadal dysfunction, adrenal hyperplasia or adenoma caused by aldosteronism There may be signs such as hypocalcemia, hypernatremia, and periodic spasm. If these diseases cause acute hypertension, if no active treatment is taken, the patient will die of uremia or heart and brain disease for more than a few years.
The patient has no symptoms in the early stage until the vision is reduced or the fundus examination is performed due to the whole body signing from the internal medicine. The most important change is optic disc edema and retinal edema, called hypertensive neuroretinopathy, and optic disc edema begins. The nasal boundary is blurred, gradually expanding to the entire optic disc, and the surrounding retina is edematous. The optic disc edema is generally obvious, which can be as high as 6PD, and the physiological blind spot is enlarged. In the past, optic disc edema was caused by brain tissue edema and increased intracranial pressure. However, many patients have intracranial pressure in the normal range, so the two are not causal. Because of the sharp increase in blood pressure, the retinal vascular barrier is damaged, causing blood to form exudation, causing edema, exudation and hemorrhage of the retina, and retinal edema. At the beginning of the optic disc, the mist is grayish white, and then spreads to the entire posterior retina. The thinned artery and the swollen vein are hidden in the edema of the edema. The retinal hemorrhage is mostly located in the nerve fiber layer, which is linear or flaming. Can be small; can also be arranged in a cluster of radial, large Tube thrombosis, cotton plaques located in the posterior pole, along the radial capillaries around the optic disc, began to appear grayish white, the edges are unclear, the appearance of a fluffy appearance can be 1/4 ~ 1/2 PD, when they are absorbed, lost The villous appearance becomes granular, and hard exudation sometimes occurs, starting with a fine distribution of yellow and white spots, often located in the macular area. When they are dense, they can be arranged in the macular area in a radial or star shape, or on the nasal side of the optic disc or The upper and lower vascular arches of the temporal side are sometimes fused together to form a large piece of exudation covering the macular area. There is a focal yellow-white point-like exudation under the retina, called Elschnig plaque. If it is treated in time, the cause is removed, blood pressure is lowered, and the fundus is lowered. The lesions can gradually subside. If there is a report of pheochromocytoma, the tumor should be removed in time. Most of the retinopathy disappears 3 months after the operation, and disappears completely after 1 year. If the timely or appropriate treatment is not obtained, the advanced fundus artery can be presented. Silver filiform or completely occluded with white lines, the retina caused by optic disc and/or retinal neovascularization due to ischemia, and some patients did not wait until the end of the fundus to change, Due to the heart, brain, kidney disease and death.
When the blood pressure of hypertension is strongly increased, the retina may have a wide range of edema opacity, hemorrhage and different nature, the form of white lesions, called retinopathy, retinopathy is a worsening of chronic progressive hypertension or acute progressive high An important indicator of blood pressure disease is caused by a sharp increase in blood pressure, damage to the retinal capillary wall, destruction of the blood-retinal barrier, and formation of plasma and blood from the capillaries into the retina.
Examine
Examination of malignant hypertensive retinopathy
Fluorescence angiography showed that the optic disc telangiectasia was distorted, and there were microangioma formation, fluorescein leakage in the late stage, and a large amount of fluorescein leakage in the retinal capillaries, which was equivalent to capillary occlusion in the cotton-floc-like plaque area, forming a small non-perfusion. Area, the telangiectasia around it, microangioma formation, and fluorescein leakage, equivalent to low perfusion or no perfusion of choroidal capillaries at Elschnig plaque, fluorescein leakage in the late stage, narrow arteries, venous filling distortion .
Diagnosis
Diagnosis and diagnosis of malignant hypertensive retinopathy
According to the patient's medical history, blood pressure and fundus signs are easy to diagnose.
The main distinguishing points from other lesions that can cause retinal edema, cotton lint and bleeding are mainly the blood pressure of the patient.
