A Case Report of Misdiagnosed Visual Loss with Hypertension in Rural Area: Wider Perspective on Ophthalmological, Neurological, and Obstetrical View.

Introduction: Sudden visual loss presented with hypertension is an ophthalmologic emergency that correspond with vascular etiology. This phenomenon needs a sharp analysis considering that the pathophysiological process could be risen from various organ system. Case Illustration: A 46-year-old woman with unknown pregnancy experienced sudden visual loss accompanied with mild headache within more than 24 hours before being admitted to the emergency room. Her blood pressure was 240/160 mmHg with visual acuity was light perception. There were no other visual or neurological related complaints. There were no problems found in ocular or neurological examination. Due to facilities limitation in rural setting, fundus examination couldn’t be performed. The patient was suspected as a sudden visual loss caused by an acute stroke, whereas the pregnancy wasn’t expected in this case. Dual anti-platelet and antihypertensive therapy were started immediately. Visual improvement was showed in 12 hours after initial therapy. Unexpectedly, two days after the treatment, the patient experienced abdominal pain with vaginal bleeding, followed by abrupt fetal release. Discussion: The following incident implied that the actual etiology was a severe pre-eclampsia. Pre-eclampsia-induced visual loss is still a rare phenomenon, contributing to the lack of physician’s concern about pregnancy-induced hypertension as the actual etiology. Result: Identification of an acute stroke from its mimics or chameleons have been a serious challenge for physicians to bear a prompt decision-making. Conclusion: Comprehensive analysis is crucial in patient assessment to identify the right etiology and generate prompt treatment. Ophthalmological, neurological, and obstetrical approach in patient care should be elaborated to bring out an optimum outcome.