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Severe bilateral optic disc edema
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A 37yo obese, white, Hispanic female presented to the hospital with a several month hx of headache- most recently accompanied by "blurry vision", intermittent horizontal diplopia, dizziness and nausea/vomiting. She had no prior medical or ocular hx and denied the use of any prescription medications or any hx of trauma.
She was admitted to the neurology service, and a full medical work-up was completed. CT scan of the brain was normal. A lumbar puncture was performed; the opening pressure was significantly elevated; the CSF composition was normal.
Ophthalmology was consulted. Her VA was 20/200 OD and 20/100 OS; no RAPD was present. Color vision testing using Ishihara plates was diminished OU, but no specific pattern of color vision deficiency was present. Pupillary examination, IOP and ocular alignment were normal. Extraocular motility revealed a mild R CN VI palsy- elicited only in extreme R gaze. Anterior segment examination was normal OU. formal visual field testing revealed a markedly enlarged blind spot with significant peripheral field loss OU; the patient was a statistically reliable test-taker. Posterior segment examination revealed a normal retinal periphery and vitreous OU; retinal vasculature, optic nerve and posterior pole findings are illustrated in the accompanying photos.
Tags
optic disc edema, curbside, diplopia, headache
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