A 49-year-old presents with 20/50 vision and an RAPD. What is your diagnosis?
Please watch this patient's response to the swinging flashlight test.
Analysis
This patient had visual loss over a 1 year period and had a significant relative afferent pupillary defect (RAPD - see video). Dilated examination revealed asymmetric discs. On the right there is normal neuro-retinal rim; on the left there is significant thinning of the neuroretinal rim temporally. The patient had an MRI performed with demonstrated a suprasellar intracranial mass.
The patient was diagnosed with compressive optic neuropathy and required intracranial surgery.
In this 19-minute video from Dr. Paul Freund, you will learn:
- The differential diagnosis of a patient with optic neuropathy
- How to investigate a patient with an isolated optic neuropathy
- How suprasellar masses are managed
Neuro Coach Tip
In a patient with an isolated optic neuropathy with no clear underlying cause on thorough neuro-ophthalmic history, an MRI of the orbits (with contrast) is necessary to rule out a compressive lesion.
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