A 47-year-old man presents with a 1 hour history of loss of vision one month ago. The vision has returned to normal. Vision is 20/25 from the right and 20/20 from the left. What is your diagnosis?
Analysis
On the right there is some blurring of the disc margin inferiorly. On the left there is some disc hyperemia, loss of cup, and more significant inferior disc swelling. There are also a few peri-papillary hemorrhages on the left. In addition there was some loss of the RNFL on OCT and some thickening of the nervehead on disc OCT.
The patient was diagnosed with disc edema bilaterally secondary to amiodarone.
In this 23-minute video from Dr. Paul Freund, you will review:
- The differential diagnosis of optic neuropathy with disc edema
- How to differentiate papilledema from disc edema
- Review how to work-up a patient presenting with disc edema
Neuro Coach Tip
In a patient over the age of 50 presenting with disc edema, consider the possibility for giant cell arteritis; emergent management is warranted (ESR, CRP and prompt initiation of steroids).
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