Valsalva retinopathy induced by handstand: a case report
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CASE REPORT
Open Access
Valsalva retinopathy induced by handstand: a case report Toshiya Miyaki1, Teruyo Kida1, Shou Oosuka1, Masanori Fukumoto1, Takaki Sato1, Masayuki Nakajima2 and Tsunehiko Ikeda1*
Abstract Background: Valsalva retinopathy is known to occur as a sudden preretinal or sub-internal limiting membrane hemorrhage induced by a rapid rise in venous pressure following increased intrathoracic or intraabdominal pressure. Here we report a case of Valsalva retinopathy that was probably induced by straining that occurred due to following a handstand. Case presentation: A 15-year-old boy became aware of decreased visual acuity in his left eye immediately after doing a handstand for approximately 10 s during physical education class, and subsequently visited a local clinic on the same day. Upon examination, a vitreous hemorrhage (VH) in the posterior pole of the fundus was found in his left eye, and he was subsequently referred to our department 7 days later. Upon examination, the VH around the optic nerve head of the left eye appeared to be resolved, and an oval-shaped sub-internal limiting membrane (subILM) hemorrhage was found in the superonasal side of the optic nerve head. No abnormalities were observed in the macular area. Four months later, the sub-ILM hemorrhage was found to have spontaneously resolved. Subsequent fluorescein angiography examinations revealed no abnormal findings at the lesion site. Conclusions: In this patient, we hypothesize that the Valsalva retinopathy was induced by straining that occurred due to a handstand, and that the resultant sub-ILM hemorrhage progressed to VH. Keywords: Valsalva retinopathy, Handstand, Vitreous hemorrhage (VH), Sub-internal limiting membrane (sub-ILM) hemorrhage
Background Valsalva retinopathy was first reported by Duane et al. in 1972 [1], and it is known to occur as a sudden preretinal hemorrhage induced by a rapid rise in venous pressure following an increased intrathoracic or intraabdominal pressure due to a Valsalva-type maneuver, such as a cough, vomiting, or a physical strain. In cases of Valsalva retinopathy, a sub-internal limiting membrane (subILM) hemorrhage or preretinal hemorrhage often occurs in the posterior pole or around the optic nerve head. Moreover, an intraretinal, subretinal, or vitreous * Correspondence: [email protected] 1 Department of Ophthalmology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan Full list of author information is available at the end of the article
hemorrhage (VH) can also occur [2]. It has previously been reported that Valsalva retinopathy can occur due to a variety of causes, such as vomiting, the lifting of a heavy object, the physical strain that occurs during child birth [3], and general anesthesia [4], yet there are very few reports of Valsalva retinopathy occurring due to a handstand [5]. Here we report a rare case of Valsalva retinopathy that was probably induced by straining that occurred following a handstand.
Case presentation A 15-year-old boy suddenly noticed
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