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The general physical examination was normal but neurological examination showed no perception of light in the left eye with an afferent pupillary defect and a normal appearance of the retina and optic disc. The right eye had a normal visual field, acuity, pupillary response, and fundus. There was no meningism and the rest of the neurological examination was normal. The clinical impression was of an isolated lesion of the left optic nerve. InvestigationsHaemoglobin 11 -8 g/l, white cell count 4-1 x 109/ with a total lymphocyte count of 1-4 x 109/l, CD4 lymphocyte count 0-09 x 1094/ (normal 0-35-2-2 x 109/1), platelets 31 x 1 09/; erythrocyte sedimentation rate 30 mm/hour; urea and electrocytes normal; liver function tests normal; hepatitis B virus surface and e-antigens detected; serum cryptococcal antigen negative.CSF analysis. Protein 0 3 g/l, glucose 3-3 mmol/l (serum 5-6 mmol/l); oligoclonal bands negative; no cells; Gram, india ink, and ZiehlNielsen stains negative; cryptococcal antigen negative; culture and sensitivity for fungi and bacteria negative; viral culture for cytomegalovirus, herpes zoster, and herpes simplex negative; cytology negative.

The EEG is a common test ordered in the elderly population for a variety of indications such as syncope, encephalopathic states, transient unresponsive episodes, and clinical seizures. The authors analyzed the spectrum of EEG abnormalities in a series of 300 homogenous elderly patients in the southern region of Ireland who were referred for the above indications. Generalized slowing was seen in 30.7% and focal abnormalities in 9% of records. Thirteen records demonstrated focal sharp waves and one record showed generalized epileptiform discharges. Two records with seizures were identified, both with nonconvulsive status epilepticus. The incidence of ECG abnormalities was high (23%). In patients referred for syncope, the incidence of EEG epileptiform abnormalities (sharp waves) was 3%, in contrast to previous reports of 49%. In patients older than 80 years (the "old old"), EEG abnormalities were more common. The yield of the EEG for common referrals such as syncope, encephalopathy, and transient unresponsiveness is low for focal abnormalities. Electrocardiographic abnormalities were common and should be identified and treated appropriately.

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