|LETTER TO EDITOR
|Year : 2003 | Volume
| Issue : 3 | Page : 279
Seizure related valsalva-like retinopathy
J Sen, P Palimar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sen J, Palimar P. Seizure related valsalva-like retinopathy. Indian J Ophthalmol 2003;51:279
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 and Tyagi et al found no post-ictal retinal haemorrhages in the fundi of children under 2 years of age. Mei-Zahav et al 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|| |
Sandramouli S, Robinson R, Tsaloumas M, Wilshaw HE. Retinal haemorrhages and convulsions. Arch Dis Child
Tyagi AK, Scotcher S, Kozeis N, Willshaw HE. Can convulsions alone cause retinal haemorrhages in infants? Br J Ophthalmol
Mei-ZahavM, Uziel Y, Raz J, Ginot N, Wolach B, Fainmesser P. Convulsions and retinal haemorrhages: Should we look further? Arch Dis Child
[Figure - 1]