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LETTER TO EDITOR
Year : 2003  |  Volume : 51  |  Issue : 3  |  Page : 279

Seizure related valsalva-like retinopathy



Correspondence Address:
J Sen


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Source of Support: None, Conflict of Interest: None


PMID: 14601860

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How to cite this article:
Sen J, Palimar P. Seizure related valsalva-like retinopathy. Indian J Ophthalmol 2003;51:279

How to cite this URL:
Sen J, Palimar P. Seizure related valsalva-like retinopathy. Indian J Ophthalmol [serial online] 2003 [cited 2020 Mar 29];51:279. Available from: http://www.ijo.in/text.asp?2003/51/3/279/14665

Dear Editor,

Valsalva retinopathy is characterised by haemorrhagic detachments of the internal limiting membrane, intra-retinal and/or vitreous haemorrhage following a sudden rise in intra-thoracic or intra-abdominal pressure (coughing, vomiting or strenuous physical activity). A 50-year-old woman presented to us one week after a witnessed grand mal seizure. The Snellen visual acuities were 6/9 (right eye) and 1/60 (left eye). Fundus examination revealed bilateral venous engorgement with multiple intraretinal and preretinal haemorrhages including a discrete preretinal haemorrhage, one disc diameter in size, overlying the left central macular region. Full blood counts and thrombophilia screen were normal. A diagnosis of Valsalva-like haemorrhagic retinopathy was made. Two weeks post-seizure, the premacular bleed had transformed into a discrete white, spherical lesion [Figure - 1]a; the left eye visual acuity remained at 1/60. Two months post-seizure, the visual acuity had improved spontaneously to 6/9 [Figure - 1]b.

Retinal haemorrhages resulting directly from a seizure are extremely rare. Sandramouli et al[1] and Tyagi et al[2] found no post-ictal retinal haemorrhages in the fundi of children under 2 years of age. Mei-Zahav et al[3] detected one child with retinal haemorrhages following febrile convulsions in a group of 153 children, aged 2 months to 2 years. We could find no study of the incidence of retinal haemorrhages in seizures in adults. To our knowledge, this is the first report of a Valsalva - like retinopathy during a grand mal seizure in an adult patient, in the absence of a Valsalva manoeuvre.

 
  References Top

1.
Sandramouli S, Robinson R, Tsaloumas M, Wilshaw HE. Retinal haemorrhages and convulsions. Arch Dis Child 1997;76:449-51.  Back to cited text no. 1
    
2.
Tyagi AK, Scotcher S, Kozeis N, Willshaw HE. Can convulsions alone cause retinal haemorrhages in infants? Br J Ophthalmol 1998;82:659-60.  Back to cited text no. 2
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3.
Mei-ZahavM, Uziel Y, Raz J, Ginot N, Wolach B, Fainmesser P. Convulsions and retinal haemorrhages: Should we look further? Arch Dis Child 2002;86:334-35.  Back to cited text no. 3
    


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