Case of the month: Sudden loss of vision in a young male lessons learnt ; a true clinical story

Down the track of Memories:

There used to be a very good tradition of weekly grand rounds at the King AbdulAziz Specialist Hospital Taif Saudi Arabia.

Every Thursday, early in the morning , the team consisting of all specialties(Internal medicine ,Gastroenterology,Rheumatology Hematology etc) would go together and discuss few  challenging cases admitted over the past week in the Medical department of the hospital.

“Not documented means not done”.This doctrine used to be strictly followed in this hospital under the able leadership of Dr AbdulAziz Alfifi, a young physician with excellent clinical and administrative capabilities.

The scrupulous medical records of course form the backbone of any research in the hospital. The grand round was a great attempt towards this goal as it would keep all residents upto date ,as if Dr AlFifi was dropping pebbles weekly in quiet waters and ripples would spread across the whole department.

Invariably grand rounds would make Postgraduates to stay till late hours the night before, completing the medical records of their respective patients and preparing the cases for presentation.

As I recall, on one occasion ,sudden onset blindness in a young man was presented .

Dr Zaid(name changed )a young physician had developed sudden onset blindness at his home.

Brought by his distraught wife in a wheelchair to the hospital Dr Zaid was down in the dumps .

That day while Dr AlFifi was scrutinizing the file of Dr Zaid and the postgraduate was presenting the history .

Dr Khalid Mehmood sneaked in and started his clinical examination.

What are the Echo findings in this patient ? Dr Khalid inquired softly soon after he completed the examination .

“Doctor ! The echo shows mitral valve prolapse but there is no evidence of endocarditis” , the postgraduate confidently replied .

The astute clinician did not accept the echo results and recommended Transesophageal echocardiography (another form of echocardiography to look into valves of the heart more closely) to rule out endocarditis.(infection of the valve) .

Transesophageal echocardiography was done the next day and note was made of vegetations in the anterior mitral valve leaflet (Infection of the heart valve)  which were missed by the routine Transthoracic echocardiography. This had led to movement of blood clot to brain of the patient in the visual area of the brain leading to blindness (cardio embolic stroke)

Thus cause of sudden blindness was  unraveled.

Dr Zaid was started on antibiotics for his infective endocarditis .

Weeks later Dr Zaid started making very good eye contact with everyone as  he had started becoming cheerful following the recovery of his lost eyesight.