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Factitious anisocoria and orthostatic hypotension
O A Onyekwere1, H Morris, R Victor
1Department of Heart and Hypertension Research, Cleveland Clinic Foundation, Ohio 44195.
Cleveland Clinic Journal of Medicine
|May 1, 1991
Summary
A veterinarian employee experienced recurrent syncope, anisocoria, and premature ventricular beats. Surreptitious medication use was identified as the cause of these perplexing symptoms.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- A 30-year-old veterinary professional presented with recurrent episodes of syncope.
- The patient exhibited neurological and cardiac abnormalities, including anisocoria and premature ventricular beats.
Observation:
- Physical examination revealed moderate peripheral venous pooling.
- The patient's history and ocular findings suggested surreptitious medication intake.
Findings:
- The clinical presentation was linked to specific medications that, when self-administered, mimic serious medical conditions.
- Diagnostic workup did not reveal significant underlying cardiovascular or neurological pathology.
Implications:
- This case highlights the importance of considering surreptitious medication use in patients with unexplained syncope and neurological signs.
- Understanding the iatrogenic potential of certain medications is crucial for accurate diagnosis and management.
- The case underscores the need for a comprehensive patient history and targeted investigations in complex clinical scenarios.