Central Retinal Vein Occlusion Associated with Fibromuscular Dysplasia: A Case Report

Abstract

In this report, we detail a rare presentation of central retinal vein occlusion (CRVO) in a patient with fibromuscular dysplasia (FMD). A 45-year-old woman with a 12-year history of FMD presented to the ophthalmology clinic with symptoms and exam findings consistent with CRVO. Dilated fundus examination revealed disc edema, diffuse flame, and dot-blot hemorrhages, and tortuous, engorged retinal veins. The patient was diagnosed with CRVO, and she was treated with monthly anti-VEGF monoclonal antibody followed by a VEGF inhibitor. At her most recent follow-up, her macular edema was resolved and her visual acuity had markedly improved. FMD has been shown to rarely present with retinal manifestations, especially in patients with hypertension. This appears to be first case report to document CRVO in the context of known FMD. We suggest that CRVO be considered as a potential complication for young patients with FMD.

Pituitary Apoplexy (PA): Delayed Diagnosis of a Rare Clinical Syndrome in a Patient With a Known Pituitary Adenoma

“…Pituitary adenomas are typically benign; however, their high metabolic requirements coupled with limited vascularization and poor angiogenesis increases their susceptibility to hemorrhage and infarction [4,8]. Pituitary adenomas are thus sensitive to changes in perfusion and several of the precipitating risk factors for PA are those which may affect hemodynamic stability or increase intratumoral or intrasellar pressure [1,4,[8][9][10]. Although asymptomatic hemorrhage of a pituitary adenoma is not uncommon, hemorrhage or infarction of a pituitary adenoma typically occurs acutely, resulting in sudden onset of severe headache [3].…”

“…PA is typically associated with the presence, and spontaneous rupture, of a pituitary adenoma, which can result in deficits to neurological and endocrine function [1]. Several different PA grading scales exist to characterize the degree of deficit resulting from the occurrence of PA [1]. Although PA occurs predominantly in patients with a pituitary adenoma, the incidence of PA within this patient population remains difficult to approximate, with a high variation in estimates ranging from 1% to 26% [1][2][3][4].…”

“…Pituitary apoplexy (PA) is an acute life-threatening clinical emergency of the endocrine system, characterized by sudden hemorrhage or infarction of the pituitary gland [ 1 ]. PA is typically associated with the presence, and spontaneous rupture, of a pituitary adenoma, which can result in deficits to neurological and endocrine function [ 1 ]. Several different PA grading scales exist to characterize the degree of deficit resulting from the occurrence of PA [ 1 ].…”

“…Several different PA grading scales exist to characterize the degree of deficit resulting from the occurrence of PA [ 1 ]. Although PA occurs predominantly in patients with a pituitary adenoma, the incidence of PA within this patient population remains difficult to approximate, with a high variation in estimates ranging from 1% to 26% [ 1 - 4 ].…”

“…The most common early clinical manifestation of PA includes acute onset of severe headache with visual impairment, hemiparesis, nausea/vomiting, and/or ocular palsy [ 1 , 3 , 5 ]. More specifically, it is noteworthy to mention that PA is commonly associated with ocular palsy of the third cranial nerve (CN III) [ 5 ].…”