A 30 Year Old Man Presents With Headaches And Symptoms Of Transient Visual Loss

A 30 year old man come to his physician complaining of chronic headaches that has started about 6 months ago. He describes the headache as a diffuse pain, worse in the mornings and sometimes associated with nausea. The pain extends into the neck and the back. He was not much concerned about his headaches but for the last few weeks he is having episodes of transient visual loss in one or both eyes that lasts for up to 30 seconds. The visual loss is sometimes related to changing posture. .

On examination patient is a well appearing obese man with normal vitals.
The fundoscopic findings are shown below:

The features of Papilledema (optic disc swelling ) is seen.

Definition Of Papilledema: Is the swelling of the optic disc caused by a raised intracranial pressure. It is usually bilateral.


Causes Of Papilledema: includes conditions that can lead to raised intracranial pressure. They are listed below:

• Idiopathic intracranial hypertension ( also known as pseudotumor cerebri)
• Brain tumor
• Malignant systemic hypertension
• Severe respiratory failure
• Meningitis
• Gullain Barre Syndrome
• Hypervitaminosis A
• Glaucoma.
• Central retinal vein occlusion
• Acute mountain sickness or high altitude cerebral edema.

Clinical features: The symptoms of paplilledema are secondary to the underlying cause of high intracranial pressure. Theses may include:

• Headache.
• Nausea/vomiting
• Pulsatile tinnitus
• Visual symptoms that include transient visual obscurations, double vision, blurring of vision and or visual field defects.
• If left untreated eventually leads to total vision loss in later stages. 
• Sometimes noticed in asymptomatic patient on routine fundoscopy. 

Management: Underlying pathology should be diagnosed and treated accordingly to prevent vision loss.