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JAMA Clinical Challenge
March 3, 2015

A 55-Year-Old Man With Severe Papilledema

Author Affiliations
  • 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
JAMA. 2015;313(9):963-964. doi:10.1001/jama.2015.0800

A 55-year-old man presenting to the emergency department reported blurry vision in his right eye during the past week. He also noticed rhythmic pulsing sounds in both ears during the past month. Past medical history was significant only for well-controlled hypertension treated with irbesartan (300 mg daily) and poor vision in the left eye for many years attributable to presumed inactive ocular histoplasmosis.

On presentation, the patient appeared well, with blood pressure of 140/70 mm Hg and a regular heart rate of 75/min. Best corrected visual acuity was 20/200 (right eye) and counting fingers at 1 foot (left eye). Direct ophthalmoscopy revealed severe bilateral optic disc edema, peripapillary hemorrhages, and absent spontaneous venous pulsations (Figure 1). Findings from a full neurologic examination were otherwise normal. Findings from a plain computed tomography (CT) scan of the head were normal apart from multiple bony sclerotic lesions seen in the calvarium, skull base, and C1 vertebra.