To the Editor.
—In the recent Questions and Answers1 discussion of a 63-year-old woman with vague visual alterations, tinnitus, and hypertension, Dr Mohr provides a useful summary and concludes that "an ophthalmologic cause seems most likely." Dr Goodwin also ascribes accommodation difficulties and raises the possibility of drug-induced symptoms. At first glance, the patient's symptoms appear isolated to the ophthalmologic area, but I believe that both have missed the diagnosis. This woman suffers from a common neurologic condition known as vertebrobasilar artery insufficiency (VBAI). Because posterior circulation ischemic symptoms may be vague and mimic other conditions, the diagnosis of VBAI is often missed.It is important to recognize that tinnitus, hypertension, and the age of the patient are important clues. For example, in older patients, tinnitus may be an early warning signal of ischemia in the anterior-inferior cerebellar artery. Selective involvement of the cochlear artery may be specifically responsible
Weintraub MI. Isolated Visual Symptoms in an Older Woman. JAMA. 1995;274(4):303. doi:10.1001/jama.1995.03530040029029