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ARTICLES
Year : 1975  |  Volume : 23  |  Issue : 2  |  Page : 11-12

Angioid streaks in a case of peripheral arterial elastic tissue degeneration (Monkeberg's degeneration)


Indira Gandhi Corporation Medical College and Govt. Medical College, Nagpur, India

Correspondence Address:
S N Patil
Department of Ophthalmology, Indira Gandhi Corporation Medical College, Nagpur
India
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Source of Support: None, Conflict of Interest: None


PMID: 1236443

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How to cite this article:
Patil S N, Kate S, Padmawar B U. Angioid streaks in a case of peripheral arterial elastic tissue degeneration (Monkeberg's degeneration). Indian J Ophthalmol 1975;23:11-2

How to cite this URL:
Patil S N, Kate S, Padmawar B U. Angioid streaks in a case of peripheral arterial elastic tissue degeneration (Monkeberg's degeneration). Indian J Ophthalmol [serial online] 1975 [cited 2020 Apr 2];23:11-2. Available from: http://www.ijo.in/text.asp?1975/23/2/11/31329

An interesting case of angioid streak associ­ated with peripheral arterial elastic tissue degeneration with symptoms of bleeding per rectum, giddiness and weakness is being dis­cussed due to its rarity.


  Case Report Top


A.R. a 40 years male patient was referred to eye out patient department of Indira Gandhi Corporation Medical College, General Hospital, Nagpur for dimi­nution of vision and for any external evidence of calci­fication in the ocular tissues.

The patient was admitted to the surgical ward with the complaints of giddiness, weakness, loose motions with passing of fresh blood 3-4 times in a day. Patient was addicted to tobacco and alcohol for the last 7 years and had no such complaints in the past. On procto­scopic examination he was found to have bleeding internal piles of 1st degree at 3, 7, 11 O'clock position and was treated for that. He was transferred to medical ward as the drowsiness and mental confusion of the patient persisted.

On examination, patient was drowsy, mentally con­fused and did not answer properly. Gait was normal. Pallor was present. No icterus, cyanosis or lymphade­nopathy was present. Blood pressure was 124/80mm.

Cardio-vascular System Examination

Pulsation of the carotids were good and equal on both sides. Radial arteries were thickened and pulsa­tions were absent on both sides. Brachial arteries were firm but their pulsations were felt normally on both sides. Pulsation of dorsalis pedis and anterior tibial arteries were absent. Femoral pulsations were felt and were normal. The temporal arteries were moderately thickened and pulsations could be felt. Heart sounds were normal. Heart borders were within normal limits.

Respiratory system was normal.

Abdominal examination

Liver was palpable, firm with sharp borders and not tender. Spleen was just palpable.

Central nervous system examination

He was drowsy and mentally confused. No other abnormality was detected.

Examination of eyes

External examination of both eyes revealed no abnormality. On slit lamp examination there was no evidence of calcium deposition on cornea or lens in both eyes. Acuity of vision in both eyes was 6/ 18 and there was no improvement of vision through pin hole.

Fundus examination of both eyes

Media were clear, Disc and retinal blood vessels were normal. Patchy black pigmentary disturbances were present at many places over the whole retina. In the macular area, there was heaping of the black pigments and the foveal reflexes were absent. There were sinuous branching lines deeper to the retinal blood vessels. These lines were starting adjacent to the disc margins about 2mm away from them. The colour of the lines was black and most of the lines were broad with irregular margins and were tapering towards the ends which were directed away from the disc towards the periphery. In right eye, in upper temporal quadrant the wavy line had also a whitish sheathing all along its length. With these fundus find­ings the patient was diagnosed having angioid streaks in both eyes.

Investigations including liver and skin biopsis were normal except X ray of the forearms and hands showed vascular calcification in the region of radial artery on both sides.

Bio-chemical investigations named

Serum calcium 12 mg

Blood urea 53 mg

Serum K 5.6 mg

Serum Na 156 mg

Post meal blood sugar level 120 mg

Serum alkaline phosphatse 22.6 K.A. units


  Comments Top


Majority of the angioid streak cases are pre­sent alongwith pseudoxanthoma elasticum in which there is degeneration of elastic tissue of the skin. Obliterative arterial lesions are present in about two thirds of the cases of pseudoxan­thoma elasticum. The degeneration of the elastic lamina of the [4],[6],[9] arterial walls was demons­trated by various workers commencing at a comparatively early age. In this particular case only the elastic tissue of the arterial walls of various peripheral arteries was affected. No other associated lesion was found. The presence of angioid streaks in purely arterial elastic tissue degeneration of choroidal vessels, ciliary arteries and aorta has been mentioned by Bock. [1] From this point of view the presence of angioid streaks in peripheral arterial elastic tissue de­generation is a unique one.

Gastro intestinal tract haemorrhages in angioid streaks have been described by various workers [2],[3],[4],[7],[8] . In the present case also the patient had fresh bleeding per rectum due to internal piles and the stool examination was positive for malena indicating some gastro intestinal haemorrhage. Psychic disorders and mental fatigue are also described in angioid streaks. [5] The same symptoms were also present in this case.


  Summary Top


A rare case of angioid streaks associated with peripheral arterial elastic tissue with the symptoms of bleeding per rectum and mental fatigue has been presented.

 
  References Top

1.
Bock; 1970, Quoted by Ballantyne, A.J. in Text Book of Fundus of the Eye, Second Ed. 591.  Back to cited text no. 1
    
2.
Berlyne, 1966, Lancet, 1-77.  Back to cited text no. 2
    
3.
Beraud et al., 1962, Quoted by Duke Elder in Spt. of Ophth., IX, 726-27.  Back to cited text no. 3
    
4.
Carlbarg et al., 1959, Acta Med. Scand. Suppl. 350-1.  Back to cited text no. 4
    
5.
Duke Elder, System of Ophthal., IX, 276-727.  Back to cited text no. 5
    
6.
Keith, 1956, Quoted by Duke Elder, IX, 726.   Back to cited text no. 6
    
7.
McCanghey, 1956, Gastro Enterology, 31, 156.  Back to cited text no. 7
    
8.
Onnell, 1962, Aust. Nz. J. Surg., 32, 78.  Back to cited text no. 8
    
9.
Scheie and Freeman, 1946, Arch. of Ophth,, 35,241.  Back to cited text no. 9
    


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