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| LETTER TO EDITOR |
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| Year : 2003 | Volume
: 51
| Issue : 3 | Page : 279 |
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Seizure related valsalva-like retinopathy
J Sen, P Palimar
Correspondence Address:
J Sen
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 14601860 
How to cite this article:
Sen J, Palimar P. Seizure related valsalva-like retinopathy. Indian J Ophthalmol 2003;51:279 |
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 | |  |
| 1. | Sandramouli S, Robinson R, Tsaloumas M, Wilshaw HE. Retinal haemorrhages and convulsions. Arch Dis Child 1997;76:449-51.  |
| 2. | Tyagi AK, Scotcher S, Kozeis N, Willshaw HE. Can convulsions alone cause retinal haemorrhages in infants? Br J Ophthalmol 1998;82:659-60. [ PUBMED] [ FULLTEXT] |
| 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. |
[Figure - 1]
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