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October 31, 1977

Hypertensive Crisis With Bilateral Bullous Retinal Detachment

JAMA. 1977;238(18):1948-1949. doi:10.1001/jama.1977.03280190050030

MALIGNANT hypertension develops in approximately 1% of patients with essential hypertension. Patients may have a variety of signs and symptoms related to neurologic, cardiac, renal, or gastrointestinal systems. Presentation of malignant hypertension as near total blindness with bilateral bullous retinal detachments is exceedingly rare, but this case underscores that all physicians, regardless of specialty, must take blood pressure measurements in all patients regardless of their complaints.

Report of a Case  In a 19-year-old man, blurred vision developed three weeks prior to admission to the hospital. He was seen by an ophthalmologist who diagnosed optic neuritis and prescribed prednisone, 20 mg every other day. His vision transiently improved, but then deteriorated to the point where he could differentiate only light from dark. He was referred to Indiana University Medical Center for further examination.He had a blood pressure reading of 300/170 mm Hg, and the visual acuity was impairedbilaterally so that