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A man in his 30s with an unremarkable medical history presented with a 2-day history of headache and blurred vision. Visual acuity was 20/20 OD and 20/25 OS. Ophthalmoscopy revealed bilateral papilledema with retinal hemorrhages and nerve fiber layer infarcts. In addition, concentric wrinkles radiating from the left optic disc were observed. The presenting blood pressure was 240/166 mm Hg and, combined with end-organ damage, systemic hypertensive emergency was diagnosed.
Retinal imaging temporal to the disc demonstrated undulating folds in a “hill-valley” or sawtooth pattern involving the superficial layer of the neurosensory retina (Figure). Visual acuity recovered to 20/20 bilaterally with resolution of all retinal folds following control of systemic hypertension by oral medications.
A, Infrared reflectance image. B, Raster spectral-domain optical coherence tomographic image. Paton lines/folds are visible as lines/folds temporal to the optic disc and as serial sawtooth wrinkles in the inner retina. There is also intraretinal and subretinal fluid contiguous with the optic disc.
In 1911, Leslie Paton described retinal folds concentric with the edge of the optic disc in fatal papilledema.1 These eponymous signs are being better appreciated and classified in patients with idiopathic intracranial hypertension modern retinal imaging.2,3
Corresponding Author: Minji Jennifer Kim, BSc(Hons), MBChB, Bolton National Health Service Foundation Trust, Minerva Road, Bolton BL4 0JR, United Kingdom (firstname.lastname@example.org).
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Kim MJ, Kelly SP. Optical Coherence Tomography Imaging of Paton Folds in Papilledema With Retinopathy From Systemic Hypertension. JAMA Ophthalmol. Published online October 01, 2016134(10):e162121. doi:10.1001/jamaophthalmol.2016.2121
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