An unusual case of unilateral scleral icterus. Krishnan P, Mishra R, Jena M, Kartikueyan R. It reminds us once again of the importance of history and physical exam which remain cornerstones in evaluation and management of patients.ġ. To our knowledge this case is only the second report of unilateral icterus associated with acute stroke and is of significance in presentation and clinical findings. Our patient had no clinical evidence of heart failure or cirrhosis.
#Scleral icterus series
In his series of six cases all patients had yellow discoloration on the upper torso, face, and upper limbs only. Meakins 4 has reported localized pigmentation in patients with circulatory failure. 2 Asymmetric jaundice has been described with edema following portacaval anastomosis 3 but in these cases the edema and jaundice both occur on the same side-a result of binding of bilirubin to the albumin of ascitic fluid that dissects into subcutaneous spaces. Page and colleagues have described two cases of ipsilateral edema and contralateral jaundice associated with hemiplegia and cardiac decompensation. Jaundice in a monocular patient with glass eye may be confusing and should be considered as differential diagnosis. However, our patient had jaundice on the same side he had experienced acute stroke. 1 It has been proposed that increased vasomotor tone on the hemiplegic side in patients with ischemic stroke may lead to reduced blood flow on the side opposite to the infarction. We could find only one case of unilateral scleral jaundice with acute stroke in the literature, reported by Krishnan et al. Unilateral scleral icterus is a very rare finding and the etiology remains unknown. Please leave your thoughts below click here for answer and discussion.Īnswer: Unilateral scleral icterus with acute stroke Based on the neurologic signs and symptoms, CT of the head was performed the image is seen in Figure 2. Pacemaker spikes were observed on ECG with no new findings. Chest x-ray revealed cardiomegaly with slight pulmonary congestion. Values obtained for CBC, BMP, troponin, BNP, UA, PT/INR and PTT were all within normal limits.
All other exams revealed no pertinent findings. His strength was normal with no sensory or neurologic deficit. He had no visual acuity deficit and EOM was within normal limits. On physical examination, left scleral jaundice was noted (Figure 1). His past medical history included hypertension, arthritis, atrial fibrillation, dyslipidemia, dementia, GERD, and cardiac pacemaker placement. The family called his primary care physician who advised ED evaluation. The symptoms lasted a few hours then gradually abated in intensity. His wife said that he had awoken with weakness the day before and had answered questions using only “yes” or “no.” His behavior was out of character that day and he had lost his balance in church multiple times. The family reported that he had been exhibiting strange behavior for the past 24 hours. His chief complaint was generalized weakness. An 86-year-old overweight man came to the emergency department (ED) accompanied by his daughter and spouse.
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