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Funduscopic Changes in Hypertension

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1. Funduscopic Changes in Hypertension

Funduscopic Changes in Hypertension Funduscopic Changes in Hypertension Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Funduscopic (...) Changes in Hypertension Funduscopic Changes in Hypertension Aka: Funduscopic Changes in Hypertension , Retinal Changes in Hypertension , Keith-Wagner II. Technique Dilate eye ( ) III. Grading of Hypertensive funduscopic changes GP 1 Spasm of l vessels GP 2 Constriction and sclerosis of l arterioles Arteriovenous Nicking (AV Nicking) of l vessels GP 3 Vascular changes s Exudates GP 4 Above changes & Images: Related links to external sites (from Bing) These images are a random sampling from a Bing

2018 FP Notebook

2. Is the Funduscopic Exam Worthwhile For the General Practitioner?

system. It is also an exam of an organ that often has pathology in the general population. One study found that in a screening of a primary care population, 50% of 405 patients had ocular pathology [1]. Furthermore, some of the most common conditions such as diabetes and hypertension are associated with retinal pathology [1]. The funduscopic exam has the ability to reveal a broad range of systemic diseases, including accelerated hypertension, raised intracranial pressure, miliary tuberculosis (...) in normotensive patients. More severe signs of hypertension, including microaneurysms, [10]. 5. Evidence of atheromas in peripheral blood vessels in patients with cerebrovascular disease indicates that there was a thrombotic event, as atherosclerotic plaques do not form in vessels as small as the retinal arterioles [6, 9]. Therefore, many patients with common diseases may have findings on the funduscopic examination that provide insight into their disease. While papilledema is an acute finding

2014 Clinical Correlations

3. Funduscopic Changes in Hypertension

Funduscopic Changes in Hypertension Funduscopic Changes in Hypertension Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Funduscopic (...) Changes in Hypertension Funduscopic Changes in Hypertension Aka: Funduscopic Changes in Hypertension , Retinal Changes in Hypertension , Keith-Wagner II. Technique Dilate eye ( ) III. Grading of Hypertensive funduscopic changes GP 1 Spasm of l vessels GP 2 Constriction and sclerosis of l arterioles Arteriovenous Nicking (AV Nicking) of l vessels GP 3 Vascular changes s Exudates GP 4 Above changes & Images: Related links to external sites (from Bing) These images are a random sampling from a Bing

2015 FP Notebook

4. ESC/ESH Management of Arterial Hypertension

ESC/ESH Management of Arterial Hypertension We use cookies to enhance your experience on our website. By continuing to use our website, you are agreeing to our use of cookies. You can change your cookie settings at any time. 2018 ESC/ESH Guidelines for the management of arterial hypertension | European Heart Journal | Oxford Academic Search Account Menu Menu Navbar Search Filter Mobile Microsite Search Term Close search filter search input Article Navigation Close mobile search navigation (...) Heart Journal , Volume 39, Issue 33, 01 September 2018, Pages 3021–3104, Download citation file: © 2019 Oxford University Press Navbar Search Filter Mobile Microsite Search Term Close search filter search input , , , , , , , , , , The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) Table of Contents 1 Preamble3025 2 Introduction3025 2.1 What is new and what has changed in the 2018 European Society

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2018 European Society of Cardiology

5. Optic disc haemorrhages at baseline as a risk factor for poor outcome in the Idiopathic Intracranial Hypertension Treatment Trial. (PubMed)

Optic disc haemorrhages at baseline as a risk factor for poor outcome in the Idiopathic Intracranial Hypertension Treatment Trial. The risk of optic disc haemorrhages on visual outcome in idiopathic intracranial hypertension (IIH) is unknown. We report the type and frequency of optic disc haemorrhages and other funduscopic abnormalities at baseline in the study eye of the 133 subjects enrolled in the Idiopathic Intracranial Hypertension Treatment Trial completing 6 months of follow-up.We (...) reviewed optic disc photographs to tabulate the frequency and type of optic disc haemorrhages, other funduscopic abnormalities and papilloedema grades of the study eye at baseline and analyse if their presence is associated with a poor visual outcome.27.2% of subjects had nerve fibre layer haemorrhages in at least one eye. Five of seven, 71% of subjects that met criteria for treatment failure, had nerve fibre layer haemorrhages in at least one eye (Fisher's exact test: p=0.02). There was a good

2017 British Journal of Ophthalmology Controlled trial quality: uncertain

6. Encephalopathy, Hypertensive (Diagnosis)

hypertension is associated with group 3 Keith-Wagener-Barker retinopathy, which is characterized by retinal hemorrhages and exudates on funduscopic examination Malignant hypertension is associated with group 4 Keith-Wagener-Barker retinopathy, which is characterized by the presence of papilledema, heralding neurologic impairment from an elevated intracranial pressure (ICP) With adequate control of hypertension, less than 1% of patients experience a hypertensive crisis. A hypertensive crisis is classified (...) , increasing exercise, moderation of alcohol, and avoidance of tobacco. Educate patients about medication adherence and compliance, and strongly emphasize the need for medical compliance. Explain the effects of uncontrolled hypertension, including the complications of persistent hypertension. Inform patients about signs of acute target-organ damage, including visual changes, persistent headaches, and neurological changes. Previous References Aggarwal M. Hypertensive crisis: hypertensive emergencies

2014 eMedicine.com

7. Hypertension and Pregnancy (Treatment)

a soft, intermittent S 3 to be common in normal pregnancy. Carotid bruits may reflect atherosclerotic disease due to longstanding hypertension, and Retinal changes of chronic hypertension may be noted. Previous Next: Diagnostic Overview Determining whether elevated blood pressure identified during pregnancy is due to chronic hypertension or to preeclampsia is sometimes a challenge, especially if no recorded blood pressures from the first half of the gestation are available. Clinical characteristics (...) as posterior reversible leukoencephalopathy syndrome, and it is similar to the changes observed when a nonpregnant patient has hypertensive encephalopathy. Magnetic resonance venography Magnetic resonance venography may also be performed to exclude cerebral venous sinus thrombosis. Previous Next: Ultrasonography Ultrasonography or CT scanning of the liver may be used to evaluate for subcapsular hemorrhage or infarction in the setting of persistent severe RUQ pain or markedly elevated hepatic transaminases

2014 eMedicine.com

8. Hypertension and Pregnancy (Overview)

a soft, intermittent S 3 to be common in normal pregnancy. Carotid bruits may reflect atherosclerotic disease due to longstanding hypertension, and Retinal changes of chronic hypertension may be noted. Previous Next: Diagnostic Overview Determining whether elevated blood pressure identified during pregnancy is due to chronic hypertension or to preeclampsia is sometimes a challenge, especially if no recorded blood pressures from the first half of the gestation are available. Clinical characteristics (...) as posterior reversible leukoencephalopathy syndrome, and it is similar to the changes observed when a nonpregnant patient has hypertensive encephalopathy. Magnetic resonance venography Magnetic resonance venography may also be performed to exclude cerebral venous sinus thrombosis. Previous Next: Ultrasonography Ultrasonography or CT scanning of the liver may be used to evaluate for subcapsular hemorrhage or infarction in the setting of persistent severe RUQ pain or markedly elevated hepatic transaminases

2014 eMedicine.com

9. Hypertension, Malignant (Overview)

emergencies, with similar outcomes and therapies. Accelerated hypertension is defined as a recent significant increase over baseline BP that is associated with target organ damage. This is usually seen as vascular damage on funduscopic examination, such as flame-shaped hemorrhages or soft exudates, but without papilledema. Hypertensive urgency must be distinguished from hypertensive emergency. Urgency is defined as severely elevated BP (ie, systolic BP >220 mm Hg or diastolic BP >120 mm Hg (...) believed might have resulted from coding changes in diagnostic-related groups in 2007. Mortality declined significantly for patients with malignant hypertension but not for those with hypertensive encephalopathy. [ ] Another pathologic process is the dilatation of cerebral arteries following a breakthrough of the normal autoregulation of cerebral blood flow. Under normal conditions, cerebral blood flow is kept constant by cerebral vasoconstriction in response to increases in BP. In patients without

2014 eMedicine.com

10. Encephalopathy, Hypertensive (Overview)

hypertension is associated with group 3 Keith-Wagener-Barker retinopathy, which is characterized by retinal hemorrhages and exudates on funduscopic examination Malignant hypertension is associated with group 4 Keith-Wagener-Barker retinopathy, which is characterized by the presence of papilledema, heralding neurologic impairment from an elevated intracranial pressure (ICP) With adequate control of hypertension, less than 1% of patients experience a hypertensive crisis. A hypertensive crisis is classified (...) , increasing exercise, moderation of alcohol, and avoidance of tobacco. Educate patients about medication adherence and compliance, and strongly emphasize the need for medical compliance. Explain the effects of uncontrolled hypertension, including the complications of persistent hypertension. Inform patients about signs of acute target-organ damage, including visual changes, persistent headaches, and neurological changes. Previous References Aggarwal M. Hypertensive crisis: hypertensive emergencies

2014 eMedicine.com

11. Hypertension and Pregnancy (Follow-up)

a soft, intermittent S 3 to be common in normal pregnancy. Carotid bruits may reflect atherosclerotic disease due to longstanding hypertension, and Retinal changes of chronic hypertension may be noted. Previous Next: Diagnostic Overview Determining whether elevated blood pressure identified during pregnancy is due to chronic hypertension or to preeclampsia is sometimes a challenge, especially if no recorded blood pressures from the first half of the gestation are available. Clinical characteristics (...) as posterior reversible leukoencephalopathy syndrome, and it is similar to the changes observed when a nonpregnant patient has hypertensive encephalopathy. Magnetic resonance venography Magnetic resonance venography may also be performed to exclude cerebral venous sinus thrombosis. Previous Next: Ultrasonography Ultrasonography or CT scanning of the liver may be used to evaluate for subcapsular hemorrhage or infarction in the setting of persistent severe RUQ pain or markedly elevated hepatic transaminases

2014 eMedicine.com

12. Hypertension, Malignant (Diagnosis)

emergencies, with similar outcomes and therapies. Accelerated hypertension is defined as a recent significant increase over baseline BP that is associated with target organ damage. This is usually seen as vascular damage on funduscopic examination, such as flame-shaped hemorrhages or soft exudates, but without papilledema. Hypertensive urgency must be distinguished from hypertensive emergency. Urgency is defined as severely elevated BP (ie, systolic BP >220 mm Hg or diastolic BP >120 mm Hg (...) believed might have resulted from coding changes in diagnostic-related groups in 2007. Mortality declined significantly for patients with malignant hypertension but not for those with hypertensive encephalopathy. [ ] Another pathologic process is the dilatation of cerebral arteries following a breakthrough of the normal autoregulation of cerebral blood flow. Under normal conditions, cerebral blood flow is kept constant by cerebral vasoconstriction in response to increases in BP. In patients without

2014 eMedicine.com

13. Hypertension and Pregnancy (Diagnosis)

a soft, intermittent S 3 to be common in normal pregnancy. Carotid bruits may reflect atherosclerotic disease due to longstanding hypertension, and Retinal changes of chronic hypertension may be noted. Previous Next: Diagnostic Overview Determining whether elevated blood pressure identified during pregnancy is due to chronic hypertension or to preeclampsia is sometimes a challenge, especially if no recorded blood pressures from the first half of the gestation are available. Clinical characteristics (...) as posterior reversible leukoencephalopathy syndrome, and it is similar to the changes observed when a nonpregnant patient has hypertensive encephalopathy. Magnetic resonance venography Magnetic resonance venography may also be performed to exclude cerebral venous sinus thrombosis. Previous Next: Ultrasonography Ultrasonography or CT scanning of the liver may be used to evaluate for subcapsular hemorrhage or infarction in the setting of persistent severe RUQ pain or markedly elevated hepatic transaminases

2014 eMedicine.com

14. Hypertension-related eye abnormalities and the risk of stroke (PubMed)

Hypertension-related eye abnormalities and the risk of stroke Many studies have shown that hypertensive ocular funduscopic abnormalities are clearly related to stroke, even after controlling for blood pressure and other vascular risk factors. Retinal abnormalities indicative of a breakdown of the blood-retina barrier confer a greater increase in risk for stroke than sclerotic retinal changes. Similar retinal changes also have a positive relationship to stroke mortality. In addition (...) , hypertensive ocular fundus abnormalities are reported to be associated with an increased risk for cognitive impairment, cerebral atrophy, progression of magnetic resonance imaging-defined white matter lesions, and subclinical infarction. Recent advances in fundus photography allow for improved accuracy and consistency in interpretation of funduscopic lesions, and improve the feasibility of screening for these abnormalities in at-risk patient populations. Evaluating the ocular fundus for signs

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2011 Reviews in Neurological Diseases

15. Overview of Hypertension

to sleep apnea, chronic kidney disease, or primary aldosteronism. Usually, no symptoms develop unless hypertension is severe or long-standing. Diagnosis is by sphygmomanometry. Tests may be done to determine cause, assess damage, and identify other cardiovascular risk factors. Treatment involves lifestyle changes and drugs, including diuretics, beta- blockers, ACE inhibitors, angiotensin II receptor blockers, and calcium channel blockers. (See also ) In the US, about 75 million people have hypertension (...) , an inordinate increase of > 10 to 20 mm Hg systolic BP after a large sodium load (eg, a meal of Chinese food). If the kidneys do not produce adequate amounts of vasodilators (because of renal parenchymal disease or bilateral nephrectomy), blood pressure can increase. Vasodilators and vasoconstrictors (mainly endothelin) are also produced in endothelial cells. Therefore, endothelial dysfunction greatly affects BP. Pathology and complications No pathologic changes occur early in hypertension. Severe

2013 Merck Manual (19th Edition)

16. Hypertensive Retinopathy

Canthotomy SOCIAL MEDIA Add to Any Platform Loading , MD, Vitreoretinal Diseases and Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Hypertensive retinopathy is retinal vascular damage caused by hypertension. Signs usually develop late in the disease. Funduscopic examination shows arteriolar constriction, arteriovenous nicking, vascular wall changes, flame (...) -shaped hemorrhages, cotton-wool spots, yellow hard exudates, and optic disk edema. Treatment is directed at controlling BP and, when vision loss occurs, treating the retina. Pathophysiology Acute BP elevation typically causes reversible vasoconstriction in retinal blood vessels, and hypertensive crisis may cause optic disk edema. More prolonged or severe hypertension leads to exudative vascular changes, a consequence of endothelial damage and necrosis. Other changes (eg, arteriole wall thickening

2013 Merck Manual (19th Edition)

17. CRACKCast E103 – Headache Disorders

Methylprednisolone 1000 mg daily for 3 days! Without visual symptoms: Prednisone 40-60 mg PO daily 15) What are the criteria to diagnose idiopathic intracranial hypertension? How is it managed? Young, obese, women of childbearing age CSF prod/absorp. Imbalance. Poorly understood Often have signs of increased ICP, and may have temporary visual obscurations related to postural changes; pulsatile tinnitus, n/v, dizziness. Criteria for Diagnosis of Idiopathic Intracranial Hypertension Headache that remits (...) accounted for by another ICHD-3 diagnosis, and transient ischaemic attack has been excluded. Notes: When for example three symptoms occur during an aura, the acceptable maximal duration is 3×60 minutes. Motor symptoms may last up to 72 hours.Aphasia is always regarded as a unilateral symptom; dysarthria may or may not be. 3) Describe the pathophysiology of migraine No longer thought to be vascular in origin. This hypothesis has been disproven Now vascular changes are thought to be an “epiphenomenon

2017 CandiEM

18. Imaging Program Guidelines: Pediatric Imaging

be used when applying the Guidelines. Guideline determinations are made based on the information provided at the time of the request. It is expected that medical necessity decisions may change as new information is provided or based on unique aspects of the patient’s condition. The treating clinician has final authority and responsibility for treatment decisions regarding the care of the patient and for justifying and demonstrating the existence of medical necessity for the requested service (...) and/or standards of medical practice. These include: ¾ Oncologic imaging – Considerations include the type of malignancy and the point along the care continuum at which imaging is requested ¾ Conditions which span multiple anatomic regions – Examples include certain gastrointestinal indications or congenital spinal anomalies Repeated Imaging In general, repeated imaging of the same anatomic area should be limited to evaluation following an intervention, or when there is a change in clinical status

2017 AIM Specialty Health

19. Management of Concussion-mild Traumatic Brain Injury (mTBI)

A. Appendix Contents 79 B. Introduction 79 C. Co-occurring Conditions 80 D. Headache 81 E. Dizziness and Disequilibrium 90 F. Visual Symptoms 93 G. Fatigue 94 H. Sleep Disturbance 94 I. Cognitive Symptoms 97 J. Persistent Pain 98 K. Hearing Difficulties 98 L. Smell (Olfactory Deficits) 99 M. Nausea 99 N. Changes in Appetite 99 O. Numbness 100 Appendix C: Mechanism of Injury 101 Appendix D: Evidence Table 104 Appendix E: 2009 Recommendation Categorization 108 Appendix F: Participants List 122 Appendix G (...) ) • Any alteration in mental state at the time of the injury (e.g., confusion, disorientation, slowed thinking, alteration of consciousness/mental state) • Neurological deficits (e.g., weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia) that may or may not be transient • Intracranial lesion External forces may include any of the following events: the head being struck by an object, the head striking an object, the brain undergoing an acceleration/deceleration

2016 VA/DoD Clinical Practice Guidelines

20. Abusive Head Trauma and the Eye in Infancy

damage rather than the diffuse axonal changes associated with traumatic brain injury. This concept is supported by neuroimaging (34);(35). In 13 of 37 infants reported by Geddes (32) there was axonal damage at the cranio-cervical junction. It was suggested that this injury to the respiratory centres had a role in producing hypoxia and brain damage. These studies raise the possibility of alternative explanations for the observed pathology. While previously, it was assumed that the forces used must (...) be sufficient to cause shearing injury, it is now apparent that shearing is not 20 the sole pathogenesis of the changes seen in the brain (these reports specifically excluded discussion of the aetiology of retinal haemorrhages). Although the precise level of force required to cause retinal haemorrhages remains uncertain, the majority of these children were unequivocally the victims of severe trauma. Despite having access to full documentation in 52 cases, the authors did not cite a case in which they could

2013 Royal College of Ophthalmologists

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