So this happened to me this week….
My patient went to her opthamologist for her routine eye exam. He called my office to tell me that he had been surprised to see a Hollenhorst Plaque. “As you know, Dr. Snyder, this can have important implications for your patient. I’m sure you’ll want to see her soon.”
So, I had a few questions:
1- What is a Hollenhorst Plaque?
2- What are these Important Implications?
3- I just saw this person last month, do I really need to see her again? What should I be doing?
Thoughts- please answer in the comments…
I guess this is a misnomer as it implies a cholesterol embolus and is not a true plaque (I may be wrong). Nonetheless, I would do carotid US ASAP, get a lipid panel and also try to educate patient on other risk factors including but not limited to smoking, glucose control, HTN, etc.Also, I may go ahead and prescribe statins and try to convince myself that this is as bad as ACS and my goal of LDL would be at least below 100. I have to add that I really like statins not only because of their HMG-CoA reductase activity but also because of their beneficial properties such as upregulating protective enzymes such as Heme Oxygenase-1 and plaque stabilizing properties.Zarjou
I forgot to mention that first thing is to make sure this is not an interventional emergency and then proceed with the US.Zarjou
I was wondering if we should do the carotid u/s first, or maybe go ahead and refer for endarterectomy. The H.plaques are direct evidence of cholesterol emboli. The source is almost certainly the carotids.-richard
I thinkthat you need the US to get an idea of the disease in the carotids. My patient has clean carotids- leading me to think that either this is an incidental finding of a remote event, or perhaps not a cholesterol emboli at all. I think that they have a pretty sterotypical look,but perhaps the diagnosis was wrong. I think I will put her on a statin and warn her about visual sx or TIA.