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JAMA Ophthalmology Clinical Challenge
January 2018

Abnormal Magnetic Resonance Imaging Findings in a Patient With Optic Disc Edema, Retinal Hemorrhage, and Decreased Vision

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Neurology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2018;136(1):92-93. doi:10.1001/jamaophthalmol.2017.3003

A woman in her 30s was referred for evaluation of severe bilateral optic disc edema, retinal hemorrhages, and a gradual decrease in vision during a 3-week period. She had a history of chronic migraines and reported worsening headaches during the past 3 months. The patient experienced intermittent episodes of numbness of her tongue, teeth, and upper extremities. She reported intermittent tinnitus but denied transient visual obscurations or hearing changes. Results of a review of systems were otherwise unremarkable. The patient was not taking any medications and denied a history of illicit drug use. Her best-corrected visual acuity was 20/100 OD and 20/70 OS. Extraocular movements were intact, and pupils were round and reactive with no afferent pupillary defect. Her intraocular pressure was 14 mm Hg OD and 10 mm Hg OS. Results of the patient’s anterior segment examination were within normal limits. Results of examination of her fundus are shown in the Figure, A. Magnetic resonance imaging (MRI) of the brain revealed diffuse abnormalities on T2-weighted fluid-attenuated inversion recovery sequences (Figure, B).

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