U. Schiefer, W. Schnerring, R. Burth, J. Schiller, J. Pätzold, M. Grigoleit, B. Selig, B. Hart

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

U. Schiefer, W. Schnerring, R. Burth, J. Schiller, J. Pätzold, M. Grigoleit, B. Selig, B. Hart

Ophthalmology

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Title

FR, male adolescent, 18 years oldSudden loss of vision OS, Headache

Author:Ulrich SchieferTranslation:Bill Hart

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Present History

When covering his right eye, Mr R noted a veil over the left eye, and could not see a distant sail boat that was visiblewith the right eye.

Initial diagnosis: Retrobulbar optic neuritis, OSInitial treatment: Oral corticosteroid, 100 mg Qd

Rapid weight gain ensued, and Mr R now seeks analternative therapy.

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Ocular History

Unremarkable

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

General Medical History

About 6 weeks ago: Severe upper respiratory infection

with a purulent involvement of

the right maxillary sinus

Obesity

otherwise „unremarkable“

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Family History

No ophthalmic disorders

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Social History

Student

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Other History

Unknown

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Visual Acuity/Refraction (1/2)

Snellen acuity: OD 20/15OS 20/60

Refraction: Not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Visual Acuity/Refraction - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Color Vision (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Color Vision - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Ocular Alignment (1/2)

Orthophoria

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Ocular Alignment - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Stereo Acuity (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Stereo Acuity - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Motility (1/2)

No restriction of eye movements,

No apparent diplopia,

No pain on eye movement

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Motility - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Pupils (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Pupils - Assessment (2/2)

There is a relative afferent pupillary defect OS

There is a relative afferent pupillary defect OD

Both afferent and efferent pupillary functions are normal

Pupillary function cannot be evaluated, due to elevated sympathetic tonus

There is an efferent (motor) disorder of pupil function

Please mark the correct answer:

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Pharmacological Pupillary Tests (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Pharmacological Pupillary Tests - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Visual Field (1/3)

Diagnosis: atypical optic neuritis

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Visual Field (2/3)

Pituitary Adenoma

30° Visual Field

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Visual Field - Beurteilung (3/3)

OD: Normal

OS: Suggests a temporal hemifield loss

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Amsler Grid (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Amsler Grid - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Intraocular pressures (1/2)

OD & OS: 16 mm Hg

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Intraocular pressures - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Mesoptometry (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Mesoptometry - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Dark Adaptation (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Dark Adaptation - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Other Visual Function Tests (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Visual Function Tests - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Anterior Segment (1/2)

Normal, age-consistent findings bilaterally

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Anterior Segment - Assessment (2/2)

Unknown

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Fundus (1/2)

OD OS

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Fundus - Assessment (2/2)

Optic discs have sharp margins and normal color OU - No elevation, hemorrhages, exudates or edema

Normal maculas, peripapillary fundus, retinal vessels and retinal periphery in both eyes

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Gonioscopy (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Gonioscopy - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

HRT (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

HRT - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Optical Coherence Tomography (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Optical Coherence Tomography - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

GDx (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

GDx - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Ophthalmometer (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Ophthalmometer - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

HH-Topometry (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

HH-Topometry - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Hertel Exophthalmometry (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Hertel Exophthalmometry - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Other Morphometry (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Morphometry - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Other Morphology (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Morphology - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

MRI (1/3)

R L

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

MRI (2/3)

R L

Fluid Level

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

MRI - Beurteilung (3/3)

Hemorrhage into a pituitary adenoma

Fluid-Level Formation!

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

CT (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

CT - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

PET (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

PET - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

X-ray (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

X-ray - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Angiography (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Angiography - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Fluorescein Angiography (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Fluorescein Angiography - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

ICG Angiography (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

ICG Angiography - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Echography (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Echography - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Doppler Sonography (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Doppler Sonography - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Echocardiography (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Echocardiography - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Other Imaging (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Imaging - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Pattern VEP (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Pattern VEP - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Flash VEP (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Flash VEP - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Acuity VEP (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Acuity VEP - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Ganzfeld ERG (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Ganzfeld ERG - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

ERG-Campimetry (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

ERG-Campimetry - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Pattern ERG (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Pattern ERG - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

EOG (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

EOG - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Other Elektrophysiologic Tests (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Elektrophysiologic Tests - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

ESR (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

ESR - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Routine Lab Tests (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Routine Lab Tests - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Coagulation (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Coagulation - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Uveitis Serology (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Uveitis Serology - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Immunopath. Lab Tests (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Immunopath. Lab Tests - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Differential WBC Count (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Differential WBC Count - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Other Lab Tests (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Lab Tests - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Immunopathology (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Immunopathology - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Histology (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Histology - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Other Pathology (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Pathology - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Other Tests (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Tests - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Internal Medicine Consultation (1/2)

Medicine Consult / Endocrinology:

Prolactin:

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Internal Medicine Consultation - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Neurology (1/2)

Neurological Consult:

Months of Galactorrhea

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Neurology - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Neurosurgery (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Neurosurgery - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Genetics Consultation (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Genetics Consultation - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

ENT Consultation (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

ENT Consultation - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Oral and Maxillofacial Surgery (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Oral and Maxillofacial Surgery - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Dermatology (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Dermatology - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Psychiatry (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Psychiatry - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Surgery (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Surgery - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Other Consultations (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Consultations - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Pulse (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Pulse - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

ECG (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

ECG - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Holter Monitor (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Holter Monitor - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Blood Pressure (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Blood Pressure - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

24 Hour Blood Pressure Monitor (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

24 Hour Blood Pressure Monitor - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Lumbar Puncture (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Lumbar Puncture - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

CSF Pressure (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

CSF Pressure - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Microbiology (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Microbiology - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Sleep Laboratory (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Sleep Laboratory - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Examination not done

Capillarioscopy (1/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Capillarioscopy - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Other Findings (1/2)

Examination not done

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Unknown

Other Findings - Assessment (2/2)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Sudden loss of vision OS, headache

Primary Symptom

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Diagnoses

Unknown

Your provisional diagnoses Actual diagnoses

1Pituitary-apoplexy

(Hemorrhage into a prolactinoma)

2Obesity

3Upper respiratory infection with

purulent maxillary sinusitis, right side

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Differential Diagnoses

Your differential diagnoses Differential diagnoses

Unknown

Retrobulbar Optic Neuritis

(but: lacking pain on eye

motion, and atypical sequence

of events)

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Etiology/Pathogenesis

Rapid growth of the tumor increases

the risk of pituitary apoplexy

Further reading, see „Clinical NeuroOphthalmology“

Chapter 2

Chapter 3

Chapter 12

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Therapy

Immediate neurosurgical intervention

(after imaging [MRI], including angiography)

Use bromocriptine [a dopamine (D2) antagonist] to reduce

the level of prolactinemia and shrink the tumor

Introduce with a gradually increasing dose.

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

Historical Background

• Wilbrand HL (1926) Schema des Verlaufs der Sehnervenfasern durch das Chiasma. Z Prakt Augenheilkd 59:135-144

• Wilbrand H, Saenger A. Die Neurologie des Auges. Verlag von J.F. Bergmann, Wiesbaden, 1904.

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

• Hollenhorst RW, Young BR: Ocular manifestations produced by adenomas of he pituitary gland: Analysis of 1000 cases. In: Diagnosis and treatment of pituitary tumors. Editors: Kohler PO, Ross GT, pp. 53-68. Excerpta Medica, Amsterdam, 1904

• Huber A (1977) Chiasmasyndrome - Klinik. Klin Monatsbl Augenheilkd 170:266-278.

• Horton J. In: Hoyt WF, ed. An Update in Neuro-Ophthalmology. UCSF, San Francisco, California, 1995: pp 27-38

• Schiefer U, Isbert M, Mikolaschek E, Mildenberger I, Krapp E, Schiller J, Thanos S, Hart W (2004) Distribution of scotoma pattern related to chiasmal lesions with special reference to anterior junction syndrome. Graefes Arch Clin Exp Ophthalmol 242:468-477

Literature

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

Note

The optic chiasm is the locus of the greatest risk for catastrophic loss of vision.

Chiasmal lesions produce characteristic visual field deficits that show respect for the vertical meridian (in at least one eye) and can be monocular or binocular with widely varying asymmetries.

Rapid growth of the tumor increases the risk of pituitary apoplexy.

Summary

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

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Cost Analysis

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Medical treatment Time Costs

Cost estimation according to GOÄ

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

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Optimal Approach

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Medical treatment Costs

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

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Comparison

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Your approach: Optimal approach:

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

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Evaluation of Questions

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

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Other Discussion

Unknown

FR, Male adolescent, 18 years oldSudden loss of vision OS, headacheHistory Visual Function Tests Morphology Other Findings Discussion

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