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FR, Male adolescent, 18 years old Sudden loss of vision OS, headache History Visual Function T Morphology Other Findings Discussion Note U. Schiefer, W. Schnerring, R. Burth, J. Schiller, J. Pätzold, M. Grigoleit, B. Selig, B. Hart Ophthalmology

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

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Ophthalmology. U. Schiefer, W. Schnerring, R. Burth, J. Schiller, J. Pätzold, M. Grigoleit, B. Selig, B. Hart. FR, male adolescent, 18 years old Sudden loss of vision OS, Headache. Author: Ulrich Schiefer Translation: Bill Hart. Title. - PowerPoint PPT Presentation

Citation preview

Page 1: 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

Page 2: 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

Title

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

Author:Ulrich SchieferTranslation:Bill Hart

Page 3: 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

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.

Page 4: 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

Ocular History

Unremarkable

Page 5: 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

General Medical History

About 6 weeks ago: Severe upper respiratory infection

with a purulent involvement of

the right maxillary sinus

Obesity

otherwise „unremarkable“

Page 6: 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

Family History

No ophthalmic disorders

Page 7: 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

Social History

Student

Page 8: 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

Other History

Unknown

Page 9: 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

Visual Acuity/Refraction (1/2)

Snellen acuity: OD 20/15OS 20/60

Refraction: Not done

Page 10: 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

Unknown

Visual Acuity/Refraction - Assessment (2/2)

Page 11: 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

Examination not done

Color Vision (1/2)

Page 12: 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

Unknown

Color Vision - Assessment (2/2)

Page 13: 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

Ocular Alignment (1/2)

Orthophoria

Page 14: 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

Unknown

Ocular Alignment - Assessment (2/2)

Page 15: 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

Examination not done

Stereo Acuity (1/2)

Page 16: 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

Unknown

Stereo Acuity - Assessment (2/2)

Page 17: 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

Motility (1/2)

No restriction of eye movements,

No apparent diplopia,

No pain on eye movement

Page 18: 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

Unknown

Motility - Assessment (2/2)

Page 19: 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

Pupils (1/2)

Page 20: 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

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:

Page 21: 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

Examination not done

Pharmacological Pupillary Tests (1/2)

Page 22: 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

Unknown

Pharmacological Pupillary Tests - Assessment (2/2)

Page 23: 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

Visual Field (1/3)

Diagnosis: atypical optic neuritis

Page 24: 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

Visual Field (2/3)

Pituitary Adenoma

30° Visual Field

Page 25: 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

Visual Field - Beurteilung (3/3)

OD: Normal

OS: Suggests a temporal hemifield loss

Page 26: 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

Amsler Grid (1/2)

Examination not done

Page 27: 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

Unknown

Amsler Grid - Assessment (2/2)

Page 28: 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

Intraocular pressures (1/2)

OD & OS: 16 mm Hg

Page 29: 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

Unknown

Intraocular pressures - Assessment (2/2)

Page 30: 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

Mesoptometry (1/2)

Examination not done

Page 31: 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

Unknown

Mesoptometry - Assessment (2/2)

Page 32: 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

Dark Adaptation (1/2)

Examination not done

Page 33: 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

Unknown

Dark Adaptation - Assessment (2/2)

Page 34: 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

Other Visual Function Tests (1/2)

Examination not done

Page 35: 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

Unknown

Other Visual Function Tests - Assessment (2/2)

Page 36: 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

Anterior Segment (1/2)

Normal, age-consistent findings bilaterally

Page 37: 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

Anterior Segment - Assessment (2/2)

Unknown

Page 38: 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

Fundus (1/2)

OD OS

Page 39: 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

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

Page 40: 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

Examination not done

Gonioscopy (1/2)

Page 41: 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

Unknown

Gonioscopy - Assessment (2/2)

Page 42: 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

Examination not done

HRT (1/2)

Page 43: 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

Unknown

HRT - Assessment (2/2)

Page 44: 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

Examination not done

Optical Coherence Tomography (1/2)

Page 45: 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

Unknown

Optical Coherence Tomography - Assessment (2/2)

Page 46: 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

Examination not done

GDx (1/2)

Page 47: 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

Unknown

GDx - Assessment (2/2)

Page 48: 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

Ophthalmometer (1/2)

Examination not done

Page 49: 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

Unknown

Ophthalmometer - Assessment (2/2)

Page 50: 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

HH-Topometry (1/2)

Examination not done

Page 51: 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

Unknown

HH-Topometry - Assessment (2/2)

Page 52: 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

Hertel Exophthalmometry (1/2)

Examination not done

Page 53: 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

Unknown

Hertel Exophthalmometry - Assessment (2/2)

Page 54: 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

Examination not done

Other Morphometry (1/2)

Page 55: 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

Unknown

Other Morphometry - Assessment (2/2)

Page 56: 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

Examination not done

Other Morphology (1/2)

Page 57: 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

Unknown

Other Morphology - Assessment (2/2)

Page 58: 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

MRI (1/3)

R L

Page 59: 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

MRI (2/3)

R L

Fluid Level

Page 60: 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

MRI - Beurteilung (3/3)

Hemorrhage into a pituitary adenoma

Fluid-Level Formation!

Page 61: 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

Examination not done

CT (1/2)

Page 62: 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

Unknown

CT - Assessment (2/2)

Page 63: 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

PET (1/2)

Examination not done

Page 64: 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

Unknown

PET - Assessment (2/2)

Page 65: 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

X-ray (1/2)

Examination not done

Page 66: 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

Unknown

X-ray - Assessment (2/2)

Page 67: 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

Examination not done

Angiography (1/2)

Page 68: 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

Unknown

Angiography - Assessment (2/2)

Page 69: 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

Fluorescein Angiography (1/2)

Examination not done

Page 70: 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

Unknown

Fluorescein Angiography - Assessment (2/2)

Page 71: 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

ICG Angiography (1/2)

Examination not done

Page 72: 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

Unknown

ICG Angiography - Assessment (2/2)

Page 73: 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

Examination not done

Echography (1/2)

Page 74: 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

Unknown

Echography - Assessment (2/2)

Page 75: 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

Doppler Sonography (1/2)

Examination not done

Page 76: 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

Unknown

Doppler Sonography - Assessment (2/2)

Page 77: 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

Echocardiography (1/2)

Examination not done

Page 78: 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

Unknown

Echocardiography - Assessment (2/2)

Page 79: 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

Other Imaging (1/2)

Examination not done

Page 80: 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

Unknown

Other Imaging - Assessment (2/2)

Page 81: 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

Pattern VEP (1/2)

Examination not done

Page 82: 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

Unknown

Pattern VEP - Assessment (2/2)

Page 83: 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

Flash VEP (1/2)

Examination not done

Page 84: 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

Unknown

Flash VEP - Assessment (2/2)

Page 85: 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

Acuity VEP (1/2)

Examination not done

Page 86: 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

Unknown

Acuity VEP - Assessment (2/2)

Page 87: 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

Ganzfeld ERG (1/2)

Examination not done

Page 88: 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

Unknown

Ganzfeld ERG - Assessment (2/2)

Page 89: 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

ERG-Campimetry (1/2)

Examination not done

Page 90: 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

Unknown

ERG-Campimetry - Assessment (2/2)

Page 91: 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

Pattern ERG (1/2)

Examination not done

Page 92: 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

Unknown

Pattern ERG - Assessment (2/2)

Page 93: 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

EOG (1/2)

Examination not done

Page 94: 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

Unknown

EOG - Assessment (2/2)

Page 95: 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

Other Elektrophysiologic Tests (1/2)

Examination not done

Page 96: 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

Unknown

Other Elektrophysiologic Tests - Assessment (2/2)

Page 97: 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

Examination not done

ESR (1/2)

Page 98: 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

Unknown

ESR - Assessment (2/2)

Page 99: 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

Examination not done

Routine Lab Tests (1/2)

Page 100: 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

Unknown

Routine Lab Tests - Assessment (2/2)

Page 101: 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

Examination not done

Coagulation (1/2)

Page 102: 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

Unknown

Coagulation - Assessment (2/2)

Page 103: 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

Examination not done

Uveitis Serology (1/2)

Page 104: 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

Unknown

Uveitis Serology - Assessment (2/2)

Page 105: 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

Examination not done

Immunopath. Lab Tests (1/2)

Page 106: 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

Unknown

Immunopath. Lab Tests - Assessment (2/2)

Page 107: 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

Examination not done

Differential WBC Count (1/2)

Page 108: 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

Unknown

Differential WBC Count - Assessment (2/2)

Page 109: 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

Examination not done

Other Lab Tests (1/2)

Page 110: 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

Unknown

Other Lab Tests - Assessment (2/2)

Page 111: 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

Examination not done

Immunopathology (1/2)

Page 112: 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

Unknown

Immunopathology - Assessment (2/2)

Page 113: 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

Examination not done

Histology (1/2)

Page 114: 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

Unknown

Histology - Assessment (2/2)

Page 115: 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

Examination not done

Other Pathology (1/2)

Page 116: 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

Unknown

Other Pathology - Assessment (2/2)

Page 117: 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

Examination not done

Other Tests (1/2)

Page 118: 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

Unknown

Other Tests - Assessment (2/2)

Page 119: 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

Internal Medicine Consultation (1/2)

Medicine Consult / Endocrinology:

Prolactin:

Page 120: 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

Unknown

Internal Medicine Consultation - Assessment (2/2)

Page 121: 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

Neurology (1/2)

Neurological Consult:

Months of Galactorrhea

Page 122: 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

Unknown

Neurology - Assessment (2/2)

Page 123: 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

Neurosurgery (1/2)

Examination not done

Page 124: 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

Unknown

Neurosurgery - Assessment (2/2)

Page 125: 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

Examination not done

Genetics Consultation (1/2)

Page 126: 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

Unknown

Genetics Consultation - Assessment (2/2)

Page 127: 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

ENT Consultation (1/2)

Examination not done

Page 128: 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

Unknown

ENT Consultation - Assessment (2/2)

Page 129: 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

Oral and Maxillofacial Surgery (1/2)

Examination not done

Page 130: 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

Unknown

Oral and Maxillofacial Surgery - Assessment (2/2)

Page 131: 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

Dermatology (1/2)

Examination not done

Page 132: 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

Unknown

Dermatology - Assessment (2/2)

Page 133: 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

Psychiatry (1/2)

Examination not done

Page 134: 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

Unknown

Psychiatry - Assessment (2/2)

Page 135: 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

Surgery (1/2)

Examination not done

Page 136: 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

Unknown

Surgery - Assessment (2/2)

Page 137: 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

Other Consultations (1/2)

Examination not done

Page 138: 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

Unknown

Other Consultations - Assessment (2/2)

Page 139: 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

Pulse (1/2)

Examination not done

Page 140: 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

Unknown

Pulse - Assessment (2/2)

Page 141: 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

ECG (1/2)

Examination not done

Page 142: 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

Unknown

ECG - Assessment (2/2)

Page 143: 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

Holter Monitor (1/2)

Examination not done

Page 144: 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

Unknown

Holter Monitor - Assessment (2/2)

Page 145: 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

Blood Pressure (1/2)

Examination not done

Page 146: 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

Unknown

Blood Pressure - Assessment (2/2)

Page 147: 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

24 Hour Blood Pressure Monitor (1/2)

Examination not done

Page 148: 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

Unknown

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

Page 149: 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

Lumbar Puncture (1/2)

Examination not done

Page 150: 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

Unknown

Lumbar Puncture - Assessment (2/2)

Page 151: 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

CSF Pressure (1/2)

Examination not done

Page 152: 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

Unknown

CSF Pressure - Assessment (2/2)

Page 153: 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

Microbiology (1/2)

Examination not done

Page 154: 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

Unknown

Microbiology - Assessment (2/2)

Page 155: 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

Sleep Laboratory (1/2)

Examination not done

Page 156: 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

Unknown

Sleep Laboratory - Assessment (2/2)

Page 157: 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

Examination not done

Capillarioscopy (1/2)

Page 158: 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

Unknown

Capillarioscopy - Assessment (2/2)

Page 159: 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

Other Findings (1/2)

Examination not done

Page 160: 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

Unknown

Other Findings - Assessment (2/2)

Page 161: 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

Sudden loss of vision OS, headache

Primary Symptom

Page 162: 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

Diagnoses

Unknown

Your provisional diagnoses Actual diagnoses

1Pituitary-apoplexy

(Hemorrhage into a prolactinoma)

2Obesity

3Upper respiratory infection with

purulent maxillary sinusitis, right side

Page 163: 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

Differential Diagnoses

Your differential diagnoses Differential diagnoses

Unknown

Retrobulbar Optic Neuritis

(but: lacking pain on eye

motion, and atypical sequence

of events)

Page 164: 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

Etiology/Pathogenesis

Rapid growth of the tumor increases

the risk of pituitary apoplexy

Further reading, see „Clinical NeuroOphthalmology“

Chapter 2

Chapter 3

Chapter 12

Page 165: 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

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.

Page 166: 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

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.

Page 167: 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

• 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

Page 168: 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

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

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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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Sum: 0

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Total time: 0s

Medical treatment Time Costs

Cost estimation according to GOÄ

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

Note

Optimal Approach

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Sum: 0Cost estimation according to GOÄ

Medical treatment Costs

Page 171: 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

Comparison

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Your approach: Optimal approach:

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

Note

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Evaluation of Questions

Page 173: 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

Other Discussion

Unknown

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

Note

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