Patient's Query
Hello doctor,
Wanted to present a hypothetical involving my 14-year-old daughter: My daughter had an acute rhinovirus/upper respiratory virus that began last week. She has no known cardiac issues and is very healthy. She insisted on playing three volleyball games for her high school team on Tuesday, Wednesday, and Thursday evening. She took 30 mg of Pseudoephedrine every three to four hours on the game days, totalling about 120 mg of Sudafed per day, including one dose while on the bench during Wednesday's game. Thursday midday, daughter started complaining of black blind spots in her vision and "blacking out". However, she insisted on playing the volleyball game. Took another dose of Sudafed just before the game, bringing her daily total that day to about 120 mg. She weighs 130 lbs. After the game, she was exhausted, crying, blacking out, and complaining of not being able to see. She rested for one hour at home and said she had chest pain. Took her pressure with a high-quality cuff, and it was 180/96 mmHg. Again, this was at rest, one hour after the physical activity of the game. I immediately went to the ER. All checked out fine, pressure came down. However, she now has continued scotoma (black blind spots) confirmed with a failed visual field test at the ophthalmologist. We took her for an MRI yesterday of the brain, pituitary, optic nerve, and sinus. All perfect.
My question is, could some hypertensive event in one of the games have damaged/caused these blind spots/ scotomas? Heaven knows how high her blood pressure got during the games. Will they resolve? Is she in any more danger now that the pressure is back to normal and she is not taking any decongestants?
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
I can understand how worried you are about your daughter's health. Blind spots, referred to as scotomas, can be due to many reasons, including but not limited to nutritional deficiency, optic nerve issues, strokes, brain problems, or issues at the eye level. Please spare some time to answer: Did she have blind spots in both eyes, or was it unilateral? Can you please provide details of the "failed visual test results, with the ophthalmologist"?
Returning to your primary query, microbleeds (caused by acutely high blood pressure or other factors) can sometimes lead to such issues. Such vision issues typically resolve over time if there is no underlying cause, i.e., no brain hemorrhage or stroke, no issues with the optic nerve, no problems with the eye itself, and no history of hypertension or diabetes mellitus.
The high blood pressure that is observed due to physical activity is not a big issue for vision. Young athletes have problems with high blood pressure when they have heart problems too, which can lead to cessation of the heart. But it does not fit here in this case, at all. The best thing is that her MRI (magnetic resonance imaging) came back normal.
I hope this helps.
Kindly follow up if you have more concerns.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
The blind spots are bilateral, both eyes, and the ophthalmologist was perplexed in that there was no pattern to the loss. It was very scattered and sporadic. He said, if he did not know her (he is a family friend), one would think she was making it up (but he knows she is not).
The loss was detected on the digital field test (machine where she presses a button when light flashes, one eye at a time). Her chairside vision test was 20/20.
Please help.
Thank you.
Hello,
Welcome back to icliniq.com.
I can understand your concern.
I can understand she is not making it up, and there may be something that bothered her. But in such a clinical setting, this case seems to have no long-term effects on her heart or vision (very fortunate). There seems to be no obvious medical reason based on which we can worry about what happened. The most sophisticated and precise testing has already been carried out in order to fulfil the criterion laid down to screen vision loss or defects in a case like this.
Fortunately, she passed all of these tests with flying colors. The only thing left to follow is regular well visits with the primary care Physician to see any nutritional or vitamin deficiency, e.g., vitamin B12, just to say one. Once she gets back in routine, and when she is already off of her recent medications, she will hopefully be doing perfectly fine (especially in the setting of 20/20 vision test results).
I hope this helps.
Kindly follow up if you have more concerns.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
You have been wonderful and positive. I will certainly keep up with her visits and make sure she is taking a good vitamin.
Thank you.
Hello,
Welcome back to icliniq.com.
I can understand your concern.
Happy that I was of some help to you. In the future, too, if you need assistance, you may ask me directly.
I hope this helps.
Kindly follow up if you have more concerns.
Thank you.
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Answered by Education: MBBS Professional Bio: Dr.Muhammad Majid Hanif is a highly skilled and established physician in the field of Cardiology. He listens to all the patient queries deliberately and is an expert in devising a proper treatment plan. This doctor is not available for online consultations on the platform anymore. Dr. Muhammad Majid Hanif
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Dr. Muhammad Majid Hanif
Cardiology
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