History of present illness
An 82-year-old female patient with a history of hyperlipidemia and hypertension presented urgently for central and peripheral vision loss in the right eye. She denied pain or visual symptoms in the left eye.
Ocular examination findings
Visual acuity was 3/200 in the right eye and 20/40 in the left eye with an afferent pupillary defect. Intraocular pressure was normal. External and anterior segment examination showed pseudophakia in each eye. Dilated fundus examination showed disc edema in the right eye. Humphrey visual field testing showed significant field constriction in the right eye.
Imaging
Optical coherence tomography (OCT) showed nerve edema. Fluorescein angiogram (FA) showed impaired choroidal filling temporally and nasally, extending into the arteriovenous phase in the right eye.
Questions to ask
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Has the patient had any strokes?
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No
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Has the patient had recent fevers, chills, night sweats, weight loss, headaches, scalp tenderness, or jaw claudication?
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No
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Does the patient have a history of rheumatological conditions?
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No
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Assessment
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This is a case of an 82-year-old female patient with hypertension and hyperlipidemia presenting with new-onset pallid disc edema and impaired choroidal filling on FA in the right eye.
Differential diagnosis ,
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Giant cell arteritis (GCA)
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Lupus retinopathy
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Granulomatosis with polyangiitis
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Nonarteritic anterior ischemic optic neuropathy
Working diagnosis
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GCA. The patient was found to have elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Temporal artery biopsy confirmed the diagnosis of GCA.
Multimodal testing and results
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Fundus photographs
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On fundus examination, disc edema (which may be accompanied by pallor) is often present ( Fig. 43.1 ).
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