Aging and Fall: Vision Related Signs on Head Computed Tomography

On a normal morning with passing clouds, a 69-year-old man fell on dry level ground during his regular morning walk after breakfast over the usual trail. He enjoyed good past health, without smoking and drinking, but history of bilateral consecutive retinal detachment (RD) surgery 2 years ago. He had high myopia of-10 Diopters before the eye operations, and was on nocte prostaglandin analogue, Latanoprost, for intraocular pressure (IOP) control. Latest best corrected visual acuity was Snellen 0.3 and 0.2 with IOP 13 and 11 mmHg for right and left eye respectively. His post-operative refractions were -2.5 Diopters over both eyes with glasses for distance. There was no dizziness, nor chest discomfort. Medical workup in the hospital revealed stable 24-hour blood pressure without postural hypotension, and normal blood glucose level with fasting and HbA1c. Endocrine blood tests were all normal. Detailed examinations by physicians did not reveal any cerebral or cardiovascular cause for his fall episode, whereas gait, balancing, coordination, muscle strength assessments were all acceptable. Computed tomography (CT) of the brain was normal, except bilateral regular hyperdensities over the orbits, suggestive of bilateral buckles over each globe, and trochlear calcifications (Figure 1). Visual cause for his fall was concluded.