Case History #48

Date of Consultation: 7-29-1982

HISTORY OF PRESENT ILLNESS:

This 56-year-old right-handed Hispanic female housewife was referred for neurological consultation because of visual difficulties.  Approximately 8 months prior to consultation, the patient noted the gradual onset of blurred vision, pain in her eyes, and swelling of the eyes.  The symptoms fluctuated on and off, but she did not appreciate any dramatic progression of these symptoms.  She denied any knowledge of a visual field defect, loss of vision in one eye or both eyes, or double vision (diplopia). 

NEUROLOGICAL EXAMINATION:

Mental Status Exam:  Intact.

Cranial Nerves:  Cranial nerve examination was normal except for the following.  Visual acuity was 20/100 in the right eye and 20/30 in the left eye with her glasses on.  Funduscopic examination showed some degree of atrophy of the optic discs bilaterally with the right being worse than the left.  Visual field testing revealed the inability to detect items in the lateral or temporal visual field of either eye.  The pupils were equal, round, and reacted to light and accommodation.  There was no afferent pupillary defect (APD, Marcus Gunn pupil) present.  External ocular movements were full without nystagmus or diplopia. 

Motor System:  Intact.

Reflexes:  Intact.

Sensory System:  Intact.

Cerebellar Function:  Intact.

Gait and Stance:  Intact.

Questions

1.  How would you describe or classify this patient's visual deficit?  

2.  What is the anatomical location of the lesion producing this visual deficit?  What side of the nervous system is involved by the lesion?  

3.  Explain the anatomical basis for this visual deficit.  What specific structure(s) is involved by the pathologic process?

4.  In general, what type of pathologic process was involved in this case?

5.  What diagnostic procedure(s) would you undertake at this point?

Answers