Approach to patient with unilateral optic disc edema and normal visual function

Donaldson, Laura; Margolin, Edward

doi:10.1016/j.jns.2021.117414

Cited by 5 publications

(2 citation statements)

References 75 publications

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“…In addition, even when performed correctly, ophthalmoscopy can be difficult to interpret because common and benign etiologies can mimic optic disc edema, including optic disc drusen and small, crowded, or anomalous optic nerves. 1 Bilateral optic disc edema with normal visual function in this patient is consistent with papilledema. The differential diagnosis for papilledema is broad, including idiopathic intracranial hypertension (IIH), cerebral venous sinus thrombosis (CVST), hydrocephalus, intracranial spaceoccupying lesions, and meningoencephalitis.…”

Section: Sectionsupporting

confidence: 52%

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Clinical Reasoning: A 65-Year-Old Woman With New Headache, Pulsatile Tinnitus, and Visual Disturbances

et al. 2021

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A 65-year-old previously healthy woman noticed new-onset, gradual, blurry vision in her left eye with perceived loss of peripheral vision and pulsatile tinnitus in the left ear for the past 2 weeks. In the past year, she visited 3 different emergency departments for new nonpulsatile and nonthunderclap headaches, which she described as "searing" pain. The headaches were accompanied by nausea without phonophobia or photophobia, were not worsened or triggered by recumbency and Valsalva, and did not wake her from sleep. There were no associated neurologic or systemic symptoms. A noncontrast CT scan of the brain was interpreted as normal.Visual acuity was 20/25 bilaterally. There was no relative afferent pupillary defect. On ophthalmoscopy, she had bilateral severe optic nerve head edema (Figure , A). Formal visual field testing (Humphrey 24-2) showed enlargement of the blind spots in each eye (Figure , B). The remaining neurologic examination was normal. Questions for Consideration:1. What are the red flags in this patient's headache history? 2. What is the differential diagnosis and next most appropriate imaging study to order?

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Section: Sectionsupporting

confidence: 52%

“…Ophthalmoscopy can confirm the presence of ICP by identifying optic disc edema. In addition, even when performed correctly, ophthalmoscopy can be difficult to interpret, as common and benign aetiologies can mimic optic disc edema, including optic disc drusen and small, crowded or anomalous optic nerves 1 .…”

Section: Sectionmentioning

confidence: 99%