CM: Acute Vision Loss

Question 1

What suggests vision loss due to migraine?

Answer 1

transient loss and sparkles in both eyes lasting 15-20 min, usually bilateral, tunnel vision
almost always complete recovery
may have scintillating scotoma

Question 2

In a pt with vision loss, when is referral to an opthalmologist necessary for diagnosis?

Answer 2

pts w unexplained vision loss

Question 3

flashing lights and floaters followed by shade or curtain of darkness over one eye
visual field loss begins in periphery and extends toward center
possible APD if severe

Answer 3

retinal detachment - surgery!

Question 4

painless, transient, monocular visual loss
pts over 50
curtain coming down - dev w/i 30 sec and resolve w/i 10 min (but can last 1-2 hrs)
maybe plaques at bifurcation of retinal arteries

Answer 4

amaurosis fugax

Question 5

sudden loss of vision, usually unilateral, pain on eye movement, APD*
loss becomes maximal over 3-7 days then stays stable

Answer 5

optic neuritis

Question 6

What is ischemic optic neuropathy?

Answer 6

damage to optic disc due to microvascular occlusion of posterior ciliary arteries
APD* is present

Question 7

What are the most common causes of a chiasmal syndrome?

Answer 7

tumor, aneurysm, other mass lesion

Question 8

What is the appropriate evaluation of a pt with chiasmal syndrome?

Answer 8

neuroimaging studies, preferably MRI