Thread: What Is the Right Diagnosis for Eye Pain and Blurry Vision?

What Is the Right Diagnosis for Eye Pain and Blurry Vision?

Question 1

A 52-year-old woman is being evaluated for the acute appearance of a large central scotoma. Which of the following most likely preceded her presentation?

a.Pseudotumor cerebri

b.Chronic ethanolism

c.Chlorpromazine ingestion

d.Methyl alcohol intoxication

e.Isoniazid use

-------------

Anser & Explanation:

[HIDE]
The answer is d, Methyl alcohol intoxication.
Persons who ingest methyl alcohol will usually be very ill if they survive. Acidosis is a life-threatening complication of exposure to this toxin. Isoniazid, ethambutol, streptomycin, and other drugs may produce similar field cuts, but the blind spots developing with these toxins usually appear subacutely or chronically rather than abruptly.
[/HIDE]

.

What Is the Right Diagnosis for Eye Pain and Blurry Vision?

Question 2

A 28-year-old man presents with right eye pain and blurry vision developing over 3 days. After examination and further history, a diagnosis of papillitis is made. How can papillitis be distinguished from the papilledema of increased intracranial pressure?

a.Degree of swelling of the optic disc

b.Associated homonymous hemianopsia

c.Characteristic visual loss

d.Associated limitation of eye movement

e.Loss of red reflex

-------------

Anser & Explanation:

[HIDE]
The answer is c Characteristic visual loss.

Visual loss is usually substantial with papillitis, an inflammation of the optic nerve head, and inconsequential with papilledema. Patients with papillitis usually also have pain on moving the globe and sensitivity to light pressure on the globe. About one in ten patients have both eyes involved simultaneously. Papillitis is often an early sign of multiple sclerosis.
[/HIDE]

.

.

Question 3

A 19-year-old woman with headaches and visual blurring has prominent bulging of both optic nerve heads with obscuration of all margins of both optic discs. Her physician is reluctant to pursue neurologic studies because the patient is 8 months pregnant and had similar symptoms during the last month of another pregnancy. Her physical and neurologic examinations are otherwise unrevealing. If neuroimaging studies were to be performed on this woman, they probably would reveal which of the following?

a.A subfrontal meningioma

b.Intraventricular blood

c.Slitlike ventricles

d.Transtentorial herniation

e.Metastatic breast carcinoma

-------------

Anser & Explanation:

[HIDE]The answer is c Slitlike ventricles.

Although papilledema must be considered evidence of a potentially life-threatening intracranial process, optic nerve bulging in this young woman is most likely from pseudotumor cerebri. This is a relatively benign condition that occasionally develops in obese or pregnant women. Cerebrospinal fluid pressure is markedly elevated in these patients, but they are not at risk of herniation. The condition is presumed to arise from hormonal problems. Without treatment, the increased intracranial pressure will produce optic nerve damage with loss of visual acuity.[/HIDE]

.