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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Neuro-Ophthalmology
Case 6
Patient Presentation: A 54-year-old female was seen in the emergency department for a new-onset severe headache and visual field deficit OU. The patient noted that she believes she cannot see in her periphery as well as normal. The patient’s vision was 20/40 OD and 20/25 OS. Colour vision was 9/14 OD, 12/14 OS on Ishihara plates. No RAPD was noted. Dilated eye examination was normal. The OCT RNFL and GCC are shown below:
Question: What pathology is found in the above RNFL/GCIPL OCT images?
Question: What is the next best step in evaluating this this patient in the eye clinic?
Question: Based on visual field results and the patient presentation, what is the most likely cause of her symptoms?
Learning Objectives:
1. Describe the findings on visual field and OCT with acute pituitary apoplexy
2. Time is necessary for OCT to thin compared to visual field deficit in compressive lesions
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