Welcome to Case of the Day!
Today, we’re going to discuss a patient who came into the office, a young gentleman in his early 30s. He complained of intermittent portions of his vision being missing or he was having blank spots in his vision. He had a slight amount of blurred vision.
We checked his vision. His vision was about 20/30 in each eye, so it wasn’t that reduced. While we were dilating his eyes, we did a visual field test, which showed an enlarged blind spot on his visual field. So what that means is that the optic nerve in the back of your eye, there’s no retinal tissue or rods and cones for vision, so when we do a visual field test, there’s a dark spot or blank spot where there’s no vision, even though your brain smooths that out and you don’t see it. It’s something we can find when we test.
In this case, the little dark spot or blank spot in the man’s vision was very large compared to what it would normally be. Also, when Dr. Croley looked inside his eye, he had what is called papilledema or swelling of his optic nerve.
The initial thought that Dr. Croley ad was that this person had pseudotumor cerebri. Pseudotumor cerebri happens when there is an increase in intracranial pressure. Another term for this is idiopathic intracranial hypertension, that is, the pressure inside the brain is elevated. That elevation is obvious when you look inside someone’s eye because the optic nerve is a direct extension of the brain, and you can see the swelling from the pressure in that optic nerve. That was what this young man had.
Pseudotumor cerebri is more common in women of childbearing age and women who are obese. Symptoms can include headaches, severe nausea, and vomiting. You could have intermittent total loss of vision that lasts for seconds. In his case, he had pieces of his vision he was noticing that were missing at times, and you could have dizziness and other things related to increased intracranial pressure.
We referred this person to a neurologist, and they had an MRI. It turns out he did not have pseudotumor cerebri, but he actually did have a tumor in his frontal lobe. We don’t know what type it was, and he was referred to neurosurgery.
Classically, he had the symptoms of pseudotumor cerebri, so if you have a sudden total loss of vision that lasts for seconds, headaches, nausea, vomiting, dizziness, and things along that line, then you need to see your eye doctor immediately. The most common group of people who get this by far is women of childbearing age who are overweight. The treatments for that a lot of times are Diamox, steroids, and different things as far as medically goes. If that doesn’t work, then eventually maybe surgery to release the pressure in the brain.
If you have any questions about this topic or anything else, Dr. Croley will be happy to try to answer them. If not, may God bless you with healthy eyes and great vision.
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At the Cataract & Refractive Institute of Florida, our board-certified ophthalmologist, Dr. James E. Croley III, uses state-of-the-art tools and techniques to help his patients manage their eye conditions. Dr. Croley is a member of the following professional organizations:
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