A 43 year old intravenous drug abuser presented to the accident and emergency department with a three week history of bilateral visual loss and frontal headaches. Fundoscopy revealed bilateral retinal cotton wool spots and haemorrhages and an ophthalmic opinion was requested. His blood pressure was subsequently found to be 210/140. A diagnosis of malignant hypertension was made and blood pressure was gradually controlled on oral antihypertensives. This case illustrates the importance of checking the blood pressure of all patients presenting with visual loss.
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