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Images in Neurology
Apr 2012

What Lies Beyond Plain Sight

Arch Neurol. 2012;69(4):538-540. doi:10.1001/archneurol.2011.1850

A 39-year-old man presented with 8 weeks of unilateral superior hemifield visual loss. He reported a generalized headache and a nonproductive cough for 3 months.

Visual acuity was 20/1200 OS and normal in the right eye. Slitlamp evaluation revealed an ischemic left branch retinal vein occlusion with macular edema, no evidence of uveitis, and no changes in the right eye. At 2 weeks' follow-up, bilateral disc edema was noted but with no focal neurological deficit. Enlarged cervical lymph nodes were found on systemic examination. A fluorescein angiogram did not demonstrate evidence of vasculitis or retinitis (Figure 1).