CASE 1 – BLURRED VISION

PCKatherine, 28 yo, femaleBlurred vision R eyeHPCNoticed upon awakening 3 days earlierGradually deterioratedNow has R ocular pain when moved eyesNil prior hx of neurologic symptomsNil recent infection or immunisation

Q 1Describe/demonstrate a clinical examination of the eyes that

you would perform in your GP rooms

O/E- Visual acuity R 6/24 L 6/6- R afferent pupillary defect- Central scotoma present- Fundoscopic exam normal- Rest of neurological exam normal

Refer to ophthalmologist• No intrinsic eye pathology• Agrees with our dx of Optic Neuritis

Q2 Describe the pathophysiological mechanism behind this presentation.  Describe the nerve fibres involved in the pupillary reflex.  Explain the finding of an afferent pupillary defect. 

Q3 Briefly discuss the clinical course and outcome.  What information can you give Katherine about the recovery of her vision? 

Q4 What can you tell Katherine about the risk of developing multiple sclerosis? 

Q5 What features, if any, predict a patient's likelihood of developing MS following a single episode of optic neuritis? 

One year after....- Develops painless numbness on L foot- Ascent to involve entire leg and rib cage- Less severe numbness on the other leg- Also c/o of leg weakness & urinary urgency- Has taken time off work

Q6 What can you tell Katherine now about her diagnosis? 

She is concerned about her dx of MS

Q7 What additional information can you provide about the course of her illness? 

Q8 Are there any prognostic features that might give Katherine further information?