A 16 year old black woman had an uncomplicated pregnancy. Labor was induced with IV Pitocin which was given for three 1-hour periods. On one occasion, a blood pressure of 140/92 was recorded. At no other time was the blood pressure elevated. There was no proteinuria.
Six hours after delivery she had a generalized seizure that was witnessed to last for one minute. The next morning, she complained of poor vision.
On examination six days later, visual acuity was hand-motion right eye, and 20/200 left eye. Pupils were equal and reactive to light. The media were clear. Visual fields showed central scotomas in both eyes. Ophthalmoscopy showed multiple cotton wool spots surrounding each macula. The fluorescein angiogram showed non-perfusion corresponding to the area of reduced axonal transport.
A neurologic consultant thought that her seizure was a manifestation of eclampsia. The obstetrician did not feel that she had eclampsia. No specific treatment was recommended.
One week later visual acuity had imporved to 20/200 in the right eye and 20/50 in the left eye.
Six weeks later visual acuity had imporved to 20/40 in the right eye and 20/20 in the left eye. The visual fields were full except for a small paracentral scotoma on the right. Nerve fiber bundle defects were observed in both eyes.
A project from the American Society of Retina Specialists
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