fr, male adolescent, 18 years old sudden loss of vision os, headache note u. schiefer, w....
TRANSCRIPT
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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Sum: 0Cost estimation according to GOÄ
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
Note
Other Discussion
Unknown