About a case” Bilateral papilla edema in adulthood focused from Primary Care”
Natalia ALMENDROS VÍLCHEZ, Belén VÁZQUEZ MARÍN and Lorena ARAGÓN GUILLÉN
42-year-old female patient who goes to the Primary Care Consultation. She reports that 1 month ago has had blurred, sometimes accompanied or not by holocranial headache, sometimes pungent with a duration more or less 15 minutes that gives away with paracetamol. The patient, a Family Doctor, associates it with greater stress due to the care burden at work, so she didn´t worry till was more frecuently. No allergies, no toxic habits. 3 pregnancies, last with Gestational Diabetes with prediabetes currently with recent treatment with metformin. Hypothyroidism after Hashimoto´s T with levothyroxine. Also she used topical retinol 5 days/week. BP 100/70. BMI 29. Neuro: Conscious and oriented. Language without alterations. normal cranial pairs, no dysmetry, no adidocokinesia, no Romberg, symmetric Rot not exalted. Dubious tandem. She was referred to the Emergency Service for evaluation by Ophthalmology and Internal Medicine: Posterior Pole described both eyes with loss od papillary profile confirmed with OCT a bilateral increase in thickness and Campimetry with increase in Blind Spot. Cranial CT scan and MRI without significant findings. Analytical without alterations even vitamin A in normal range. Lumbar puncturre LCR with output pressure 50mmHg, transparent with negative culture. Treatment was initiated with acetazolamida 6cp per day and potassium before the diagnosis of " Benign Idiopathic Intracranial Hype.rtension" After 9 months of oral treatment, she was referred to Neurosurgery with new tests. A venous MRI angio where it observed a bilateral transverse breast stenosis (right 3.5 cm and 2.5 cm left being hypoplastic). Endovascular treatmentof right breast stenosis was decided after checking a pre/post stenosis pressure gradient of 10 mmHg with improvement of it after the procedure. Doble antiaggregation began for 3 months, maintaining acetylsalicylic 300mg.Special case where it is highlighted how from Primary Care we can make a temporary follow- up of the patient, seeing the evolution of the symptoms, emphasizing changes in lifestyle, prevention of FRCV as well as taking care of the mental health of patients.Do not underestimate any symptoms and or signs that patients may give us.As a complicated case, it can be addressed from Primary Care and be conducted and accompaied throughout the process, always having a comprehensive focus on the patient.In summary, maintaining a good doctor-patient relationship, maintained over time,we see interesting cases for our daily practice. It is an example ot the meaning of our profession, so punished with burnt out, but that we try to take care of everyone for good health.
