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JAMA Ophthalmology Clinical Challenge
March 19, 2020

Severe Progressive Bilateral Vision Loss With Headaches

Author Affiliations
  • 1Shiley Eye Institute, Division of Oculofacial Plastic and Reconstructive Surgery, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
JAMA Ophthalmol. 2020;138(5):582-583. doi:10.1001/jamaophthalmol.2020.0362

An African American woman in her 20s presented to an outside hospital with progressive vision loss in both eyes, photophobia, and nausea, which had developed over weeks. Her home medications were hydrocodone and ibuprofen. Bilateral disc edema was noted on examination, and neuroimaging was obtained. Noncontrast head computed tomography (CT) and CT angiogram were remarkable only for bilateral optic nerve head abnormalities. Magnetic resonance imaging was concerning for prominent optic nerves (Figure, A). There was no evidence of intracranial masses, hydrocephalus, or bleed. Lumbar puncture revealed cerebrospinal fluid opening pressure of 40 cm of water. Cerebrospinal fluid protein, glucose, IgG, and oligoclonal band levels were within normal limits. Renal function was normal. The patient started receiving oral acetazolamide, 500 mg, twice daily for presumed idiopathic intracranial hypertension (IIH) and transferred to our institution.

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