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June 1987

Acute Papilledema and Visual Loss in a Patient With Pseudotumor Cerebri

Arch Ophthalmol. 1987;105(6):752-753. doi:10.1001/archopht.1987.01060060038022

To the Editor.  —Patients with papilledema usually retain normal visual acuity. I recently evaluated and treated a patient with pseudotumor cerebri in whom marked loss of central vision developed in the acute stage of papilledema.

Report of a Case.  —A 33-year-old male professional trumpet player weighing 184.5 kg complained of blurred vision of recent onset in both eyes. On examination, visual acuity was 20/200 OU. Visual fields demonstrated that both blind spots were greatly enlarged and that each extended centrally to involve fixation. Peripheral isopters showed very slight constriction. The patient could slowly identify 24 of 24 Ishihara color test plates with each eye. Pupillary responses were normal. Fundus examination revealed massive disc swelling with extensive retinal and preretinal hemorrhage in both eyes (Figure). In addition, bilateral serous detachments of the macula were noted.A computed tomographic scan of the head was normal. A lumbar puncture was performed and revealed

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