Central retinal vein occlusion due to hyperviscosity syndrome

Chiang, Charles C; Begley, S. J.; Henderson, Sean O.

doi:10.1016/s0736-4679(99)00157-2

Cited by 23 publications

(32 citation statements)

References 9 publications

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“…Abnormalities in blood coagulation and fibrinolysis are frequently found in malignancies, resulting in vascular thrombosis and thromboembolic complications [9, 10]. In a high percentage of cancer patients, laboratory parameters indicate activated coagulation and fibrinolysis, characterized by elevated plasma concentrations of clotting factors, fibrinogen and fibrin/fibrinogen degradation products [11].…”

Section: Discussionmentioning

confidence: 99%

“…CRVO in multiple myeloma and dysproteinemias is frequently related to hyperviscosity states [1, 9, 10]. The hyperviscosity syndrome is a collection of symptoms and clinical findings that may reflect increased serum concentration of a monoclonal protein [11].…”

Section: Discussionmentioning

confidence: 99%

“…Although no laboratory measurements of serum viscosity were performed, she presented very high IgG levels (5,550 mg/dl; normal range: 672–1,440 mg/dl) that justified her clinical symptoms [1, 10, 11, 14, 15, 18]. …”

Section: Discussionmentioning

confidence: 99%

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Bilateral Central Retinal Vein Occlusion Associated with Multiple Myeloma

et al. 2004

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Purpose: To report a case of simultaneous bilateral central retinal vein occlusion (CRVO) associated with multiple myeloma. Methods: A 65-year-old woman had sudden, painless loss of vision in both eyes for 20 days. Ophthalmologic examination revealed bilateral CRVO. Appropriate medical workup was conducted, and multiple myeloma was diagnosed as the underlying cause. Results: Clinical support and chemotherapy effectively controlled paraprotein production, leading to improvement of both systemic and ocular alterations. Conclusions: Many conditions have been noted to be associated with CRVO. Based on a Medline search, this is the first report of simultaneous bilateral CRVO as the first manifestation of multiple myeloma, illustrating the need for a primary care ophthalmologist to be involved in the basic assessment for associated underlying diseases in retinal disorders.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Bilateral Central Retinal Vein Occlusion Associated with Multiple Myeloma

et al. 2004

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“…Blood viscosity is measured in centipoise (cP) and varies according to the hematocrit, red cell aggregability, and plasma viscosity (6,7). Symptoms related to hyperviscosity syndrome occur more frequently when the viscosity is above 6 cps, as was the case in our patient; however, the level of viscosity at which the symptoms become apparent varies among patients (6).…”

Section: Dr Alzaga Fernandezmentioning

confidence: 75%

Bilateral Simultaneous Central Retinal Vein Occlusions in an Otherwise Healthy Adult

Fernández

Shirka

Skarf

et al. 2011

Journal of Neuro-Ophthalmology

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A 53-year-old man presented with a 5-day history of progressive painless loss of vision in his right eye and a 1-day history of a similar deterioration in the left eye. He denied headaches, diplopia, transient visual obscurations, or other neurological symptoms. He stated that he was in good health and denied any systemic diseases. He was a vegetarian who exercised regularly.Ophthalmological examination revealed that the patient's best-corrected visual acuity was 20/200 in the right eye and 20/40 in the left eye. His pupils were equal and reactive to light; there was a questionable right relative afferent pupillary defect. Confrontation visual field testing showed that he could count fingers in all quadrants of both eyes. Kinetic perimetry of the right eye performed using the I-4e and I-2e test targets showed a moderately dense central scotoma, an enlarged blind spot, and slightly constricted peripheral isopters. The central scotoma in the right eye was confirmed using an Amsler grid. In the left eye, kinetic perimetry showed minimal constriction of the isopters superotemporally. With an Amsler grid, the patient noted distortion and waviness of lines superotemporally. The patient was able to identify 12 of 15 Ishihara plates with the right eye by fixating eccentrically with his nasal field. He identified all 15 color plates with his left eye. Extraocular movements were full, and the slit-lamp examination revealed no abnormalities. Intraocular pressures were within normal limits. Both optic discs were swollen and surrounded by multiple flame-shaped hemorrhages that radiated from the optic discs and obliterated the disc margins (Fig. 1). Small exudates and scattered dot and blot hemorrhages surrounded both optic discs; there was no substantial hemorrhage noted along the retinal vascular arcades outside the immediate peripapillary area. In both eyes, the retinal veins appeared distended and engorged, with boxcarring of the blood column. There were serous macular detachments in both eyes. There were no abnormalities in the retinal periphery of either eye.Patient evaluation showed mild pancytopenia (white blood cell count, 3.1 K/mL; hemoglobin B, 9.7 g/dL; platelets, 135 K/mL), high serum protein, low serum albumin, and high lactate dehydrogenase. Serum vitamin B12, folate, and iron levels were normal. CT and MRI of the brain, MRA, and venography were performed. Dr. Luetmer:CT of the head without contrast shows no abnormalities; however, magnetic resonance studies reveal a poorly defined heterogeneous infiltrate involving the clivus consistent with a marrow replacement process (Fig. 2). Dr. Skarf:Given the magnetic resonance findings, a whole-body bone scan and a metastatic bone survey were performed. Dr. Luetmer:The bone scan shows multiple areas of uptake involving the ribs on both sides, the right scapula, and the left femur (Fig. 3). The metastatic bone survey reveals vague lucencies throughout the skull. Dr. Skarf:Serum electrophoresis with immunofixation revealed a large IgA lambda monoclonal protein in the beta...

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“…30 The viscosity itself is most directly responsible for the retinopathy, probably because of paraprotein-induced red-cell aggregation in the microcirculaton. [9][10][11]14,31 The anemia that results from hypervolemia is dilutional and may be somewhat protective. 15 Other causes of anemia that have been reported in patients with serum hyperviscosity syndromes include chronic hemorrhage, iron deficiency, shortened red-cell survival, Coombs'positive hemolytic anemia, and insufficient production of erythropoietin.…”

Section: Presentation Of Casementioning

confidence: 99%

Case 6-2002

Weinstein¹,

Mahmood²

2002

N Engl J Med

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Figure 3. Skeletal Survey Showing Diffuse Osteopenia of the Bony Structures. In the skull (Panel A), there are numerous, discrete lytic foci that are fairly regular in size and shape. Additional lytic foci are present in the humerus and femur (Panel B, arrows) and in the pubic ramus (Panel C, next page) bilaterally.Figure 2. Results of Urinary Protein Electrophoresis. A high-concentration band (arrow) and a low-concentration band (arrowhead) in the gamma region are Bence-Jones protein and an IgG lambda M component, respectively. A B The New England Journal of Medicine Downloaded from nejm.org at STOCKHOLMS UNIVERSTITETSBIBL on August 11, 2015. For personal use only. No other uses without permission.

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Central retinal vein occlusion due to hyperviscosity syndrome

Cited by 23 publications

References 9 publications

Bilateral Central Retinal Vein Occlusion Associated with Multiple Myeloma

Bilateral Central Retinal Vein Occlusion Associated with Multiple Myeloma

Bilateral Simultaneous Central Retinal Vein Occlusions in an Otherwise Healthy Adult

Case 6-2002

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