The twists and turns of optic disk swelling in a teenager

Michael C. Brodsky; Grant T. Liu

doi:10.1016/j.survophthal.2012.01.012

The twists and turns of optic disk swelling in a teenager

Michael C. Brodsky, Grant T. Liu

Ophthalmology

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

A 17-year-old girl developed headaches, transient visual obscuration, pulsatile tinnitus, and hearing loss during an episode of pneumonia. Neuro-ophthalmologic examination disclosed severe bilateral optic disk swelling and macular exudate in the right eye. Lumbar puncture showed an opening pressure of 55 cm H₂O without neurochemical abnormalities. Subsequent magnetic resonance imaging showed no mass lesion or signs of venous sinus thrombosis, confirming the diagnosis of idiopathic intracranial hypertension. Following the lumbar puncture, the papilledema resolved but visual acuity decreased to 20/40 in the right eye despite normal color vision. Perimetric signs of psychogenic visual loss developed. This case underscores that hyperacute papilledema can simulate bilateral optic neuritis and illustrates the importance of color vision testing in distinguishing macular visual loss from optic neuropathy. It also illustrates the confounding effect of psychogenic visual loss in judging the clinical course of idiopathic intracranial hypertension.

Original language	English (US)
Pages (from-to)	273-277
Number of pages	5
Journal	Survey of ophthalmology
Volume	58
Issue number	3
DOIs	https://doi.org/10.1016/j.survophthal.2012.01.012
State	Published - May 2013

Keywords

Optic disk swelling
Papilledema
Psychogenic visual loss

ASJC Scopus subject areas

Ophthalmology

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10.1016/j.survophthal.2012.01.012

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title = "The twists and turns of optic disk swelling in a teenager",

abstract = "A 17-year-old girl developed headaches, transient visual obscuration, pulsatile tinnitus, and hearing loss during an episode of pneumonia. Neuro-ophthalmologic examination disclosed severe bilateral optic disk swelling and macular exudate in the right eye. Lumbar puncture showed an opening pressure of 55 cm H2O without neurochemical abnormalities. Subsequent magnetic resonance imaging showed no mass lesion or signs of venous sinus thrombosis, confirming the diagnosis of idiopathic intracranial hypertension. Following the lumbar puncture, the papilledema resolved but visual acuity decreased to 20/40 in the right eye despite normal color vision. Perimetric signs of psychogenic visual loss developed. This case underscores that hyperacute papilledema can simulate bilateral optic neuritis and illustrates the importance of color vision testing in distinguishing macular visual loss from optic neuropathy. It also illustrates the confounding effect of psychogenic visual loss in judging the clinical course of idiopathic intracranial hypertension.",

keywords = "Optic disk swelling, Papilledema, Psychogenic visual loss",

author = "Brodsky, {Michael C.} and Liu, {Grant T.}",

note = "Funding Information: The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article. The article was supported in part by a grant from Research to Prevent Blindness, Inc., New York, New York. Copyright: Copyright 2013 Elsevier B.V., All rights reserved.",

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AU - Liu, Grant T.

N1 - Funding Information: The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article. The article was supported in part by a grant from Research to Prevent Blindness, Inc., New York, New York. Copyright: Copyright 2013 Elsevier B.V., All rights reserved.

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N2 - A 17-year-old girl developed headaches, transient visual obscuration, pulsatile tinnitus, and hearing loss during an episode of pneumonia. Neuro-ophthalmologic examination disclosed severe bilateral optic disk swelling and macular exudate in the right eye. Lumbar puncture showed an opening pressure of 55 cm H2O without neurochemical abnormalities. Subsequent magnetic resonance imaging showed no mass lesion or signs of venous sinus thrombosis, confirming the diagnosis of idiopathic intracranial hypertension. Following the lumbar puncture, the papilledema resolved but visual acuity decreased to 20/40 in the right eye despite normal color vision. Perimetric signs of psychogenic visual loss developed. This case underscores that hyperacute papilledema can simulate bilateral optic neuritis and illustrates the importance of color vision testing in distinguishing macular visual loss from optic neuropathy. It also illustrates the confounding effect of psychogenic visual loss in judging the clinical course of idiopathic intracranial hypertension.

AB - A 17-year-old girl developed headaches, transient visual obscuration, pulsatile tinnitus, and hearing loss during an episode of pneumonia. Neuro-ophthalmologic examination disclosed severe bilateral optic disk swelling and macular exudate in the right eye. Lumbar puncture showed an opening pressure of 55 cm H2O without neurochemical abnormalities. Subsequent magnetic resonance imaging showed no mass lesion or signs of venous sinus thrombosis, confirming the diagnosis of idiopathic intracranial hypertension. Following the lumbar puncture, the papilledema resolved but visual acuity decreased to 20/40 in the right eye despite normal color vision. Perimetric signs of psychogenic visual loss developed. This case underscores that hyperacute papilledema can simulate bilateral optic neuritis and illustrates the importance of color vision testing in distinguishing macular visual loss from optic neuropathy. It also illustrates the confounding effect of psychogenic visual loss in judging the clinical course of idiopathic intracranial hypertension.

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The twists and turns of optic disk swelling in a teenager

Abstract

Keywords

ASJC Scopus subject areas

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