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July 26, 1995

Isolated Visual Symptoms in an Older Woman-Reply

Author Affiliations

University of Illinois Chicago

JAMA. 1995;274(4):303. doi:10.1001/jama.1995.03530040029031

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In Reply.  —I have no disagreement with any of Dr Weintraub's comments. I think the way one approaches this kind of deliberately vague case account depends on one's mind-set at the time of reading. The case lacks so many specific details on so many of the questions we would all have asked the patient in taking the history that it is more of a Rorschach test than a case history.Viewing the problem as one of vertebrobasilar insufficiency would require that the patient have intermittent ischemia of the brain stem many times a week for more than a year. Also, the dependence of the symptoms on shifts of gaze angle would not be easily explained, nor would the cessation of symptoms for more than a week following dilatation of the pupils. Of course, this last could be a red herring.Weintraub notes the relationship of blood flow in the vertebral

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