Teenager With One-Sided Facial Flushing and Progressive Vision Loss in Left Eye
Sixteen-year-old African American boy with progressive loss of vision in the left eye over 2 weeks. He also had pain around the left orbit with some radiation to the temple. His mother reported that one side of his face appeared to be more flushed when he exerted himself; he had not seen a physician for this problem. He had no seizures or hemiparesis and was cognitively intact.
HISTORY
Sixteen-year-old African American boy with progressive loss of vision in the left eye over 2 weeks. He also had pain around the left orbit with some radiation to the temple. His mother reported that one side of his face appeared to be more flushed when he exerted himself; he had not seen a physician for this problem. He had no seizures or hemiparesis and was cognitively intact.
PHYSICAL EXAMINATION
Well-nourished teenager in moderate pain. Pinkish discoloration on left side of face clearly evident in natural light. Left eye not injected. Visual acuity markedly reduced with only light perception on acuity testing. Retinal detachment noted on fundus examination. Cranial nerves and neurological findings normal.
IMAGING
Ultrasonogram of the orbit revealed choroidal hemorrhage in the left orbit with overlying retinal detachment. Patient's MRI scan is shown.
“WHAT'S YOUR DIAGNOSIS?”
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