Correspondence

Medical Mystery: Visual-Field Defect — The Answer

N Engl J Med 2006; 355:2493December 7, 2006

Article

To the Editor:

The medical mystery in the October 12 issue1 involved a 31-year-old woman who presented with a sudden onset of an inferonasal visual-field deficit in the left eye. Two days earlier, she had traveled for 16 hours by air. On physical examination the day after the onset of her visual symptoms, ophthalmoscopy revealed a band of opacification in the left macula that was diagnostic of a branch retinal artery occlusion, as shown on fluorescein angiography (Figure 1AFigure 1Eisenmenger's Syndrome Associated with a Ventriculoseptal Defect and a Patent Ductus Arteriosus.). The patient had digital erythema, cyanosis (Figure 1B), and severe clubbing (Figure 1C) of the hands and feet. Auscultation revealed a systolic ejection murmur over the right upper sternal border. The hematocrit was 57.4%.

The patient had Eisenmenger's syndrome associated with a ventriculoseptal defect and a patent ductus arteriosus. Anticoagulation was initiated with heparin, and she was discharged while receiving warfarin. In this case, the long airplane flight and secondary polycythemia with hypercoagulability probably led to clotting in the lower limbs, with embolism through the patent ductus arteriosus to the retina. The visual-field defect subsequently resolved.

Jeevan R. Mathura, Jr., M.D.
Lee M. Jampol, M.D.
Northwestern University, Chicago, IL 60611
imathura@gmail.com

1 References

1. 1

   Mathura JR Jr, Jampol LM. Medical mystery -- visual-field defect. N Engl J Med 2006;355:1592-1592
   Full Text | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Mishkin, Fred, , Mishkin, Marvin, . (2007) Medical Mystery — Paradoxical Embolism. New England Journal of Medicine 356:12, 1277-1277
   Full Text

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