PSEUDO-FOSTER KENNEDY SYNDROME SECONDARY TO MALIGNANT HYPERTENSION

David Sendrowski

Abstract

BACKGROUND: There are various underlying mechanisms that cause the cerebrospinal fluid (CSF) pressure to elevate. Of these mechanisms, intracranial mass lesions are more serious and urgent to rule out. We present here a case of pseudo-Foster Kennedy Syndrome secondary to malignant hypertension. The right-sided optic pallor resulted from previous ischemic optic neuropathy diagnosed several months earlier which was caused by untreated hypertension and diabetes. This case illustrates the importance of blood pressure measurement and in-office vascular evaluation testing when confronted with edematous optic nerve disorders.

CASE REPORT(S): A 37 year old white male presented initially with a non-arteritic ischemic optic neuropathy secondary to undiagnosed hypertension and non-insulin dependent diabetes. Best corrected acuities at initial presentation were 20/100 O.D. and 20/20 O.S. Dilated fundus exam revealed mild to moderate disc edema of the right optic nerve head with an associated inferior attitudinal field loss. The left optic nerve was normal. Upon return two months later, the patient presented with disc swelling of the left optic nerve head and disc pallor of the right. The patient’s blood pressure at the second visit was 180/105 right arm sitting (RAS). Intracranial imaging was negative for intracranial lesions. A diagnosis of malignant hypertension causing secondary papilledema was made after further medical evaluation.

CONCLUSIONS: A 37 year old patient with uncontrolled hypertension and diabetes presented with an early onset of non-arteritic ischemic optic neuropathy. Upon follow-up, improperly controlled malignant hypertension led to the case presentation of optic atrophy and unilateral papilledema or pseudo-Foster Kennedy syndrome.

This case demonstrates the need for eye care practitioners to utilize simple vascular and neurologic evaluation techniques, universally taught in optometry schools, in order to provide optimum care to their patients.
ADDITIONAL COMMENTS: None

Details

Year: 2005

Program Number: 055327

Resource Type: Scientific Program

Author Affiliation: Marshall B. Ketchum University, College of Optometry

Co-Authors: Mark Bronstein, Robert Lingua

Co-Author Affiliation: Private Practitioner, Private Practitioner

Room: n/a