Case 2

1
Case 2
2
Presentation

• Patient aged 21 presents with a history of loss
  of vision lasting a few seconds in both eyes.

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First Thoughts

• What is likely to be going on?

4

• Migraine?
• Hysteria?
• Something serious?

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History Further questions

• List what further history you wish to know.

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History List

• How Long have symptoms occurred.
• Any headache?
• Is vision Ok between attacks?
• History of migraine?
• Medical history.
• What is the vision loss like ?
• Is it complete?

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Answers

• Complete loss occurs.
• Headaches have been occurring for 3 months .Worse
  in early AM.

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Examination -- general

• Female , obese 98Kgs.
• Bp 120/85.
• Otherwise NAD.

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List the Ocular examination
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Ocular Examination

• Vr 6/6 Vl6/6 no glasses.
• OM Nad.
• Pupils reactive.
• Fundisee slide

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D.Diagnosis

• List

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D.Diagnosis

• S.O.L.
• Acute bilateral optic papillitis.
• Intra cranial Hypertension.

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Tests

• List

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Pathology /Imaging

• FBC/ESR/CRP.
• CAT scan./ MRI.

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MRI Report
Summary
MRI shows ventricular dilatation both
laterals And 3Rd ventricle consistent with ICH.
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RX

• HELP!!!
• Neurosurgeon/ Neurologist
• IV Diamox
• ? Shunt.