An 85-year-old man presented with complete loss of vision. During the week prior to presentation, he reported gradually progressive blurred and dark vision in both eyes with dramatic worsening on the day of presentation. He had no other symptoms, including headache. His medical history was significant for hypertension and peripheral vascular disease.
On examination, his blood pressure was elevated. There was no cranial artery tenderness. He was alert with intact language and memory. Visual acuity was light perception OU. Both pupils were 4 mm and nonreactive to light. Eye movements were normal, and corneal reflexes were intact and symmetric. Funduscopic examination showed bilateral optic nerve head edema with right optic nerve sectoral pallor and a left macular infarction (Figure, A and B). The remainder of the neurological examination was normal. Magnetic resonance imaging showed restricted diffusion (Figure, C and D) with a reduced apparent diffusion coefficient signal (not shown) within the left intraorbital optic nerve and at the right anterior optic nerve. The platelet count was 1134/μL, the erythrocyte sedimentation rate was 40 mm/h, and the C-reactive protein level was 17.7 mg/L (to convert to nanomoles per liter, multiply by 9.524).
Funduscopic and magnetic resonance images. A, Right eye funduscopy showing a hyperemic optic nerve head with sectoral temporal pallor and an adjacent cotton-wool spot (white arrow) and a small focus of macular hypopigmentation (black arrow). B, Left eye funduscopy showing diffuse edema of the optic nerve head with blurred disc margins and a cherry-red spot (white arrow) surrounded by a macular infarct (arrowheads), as well as narrowing of the retinal arteries (black arrow). C, Axial diffusion-weighted magnetic resonance image showing restricted diffusion in the right anterior optic nerve adjacent to the junction with the globe (arrow). D, Axial diffusion-weighted magnetic resonance image showing restricted diffusion in the left optic nerve (arrow).
Thank you for submitting a comment on this article. It will be reviewed by JAMA Neurology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 13
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.