28 yr female pt p0+0,c/o headache Sudden loss of vision

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This young female with b/l mastoiditis, headache and sudden loss of vision needs to be evaluated. Mastoiditis can cause venous sinus thrombosis, gradenigo syndrome with 6 nerve palsy. Get CT brain with contrast or a MRI with contrast which cn detect any infarction or thrombus. Fundus examination to rule out optic neuritis. Seems to be sudden. Painful loss of vision. If optic neuritis, consider multiple sclerosis and mastoiditis may be a coincidental finding. Neuromyelitis optica is a related differential. She is hvng transaminitis also. Get usg abdomen and viral markers done. Any fever? T.l.c is normal. So, I dnt assume any acute infectitious process. Glaucoma at her age is less likely.mastoiditis is known to cause temporary vision loss in rare cases. Also rule out connective tissue disorders. Esr? Platelets are on the lower side along with transaminitis. Rule out tropical fever. Widal is positive but nt specific. Cn be cnfrmd by blood c/s. Any murmur on clinical examination? Rule out cardioembolic causes of vision loss. This case requires a detailed evaluation with neurology, ophthalmology and e.n.t opinion. Methylprednisolone pulse cn be given once you get to know that it is optic neuritis. If thrombosis, anticoagulants required.

Good discussion.

PT pO+O means ? If patient is post labor or post cisserian delivery. Rule out Amniotic fluid embolism, Ocular DIC ( shower of emboli causing choroidal infarction central exudative RD ), CSR. Pre eclampsia associated hypertensive retinopathy, CRAO CRVO etc. Some time optic neuritis etc. Get fundus examination & USG posterior segment. DIC can have delayed presentation get platelet count BT CT PT INR repeated

Rule out multiple sclerosis adv MRI brain get neuro opinion


What is P o+o ? Loss f vn - unilateral or bilateral? How much is vn?

Any more history madam?

Dr pupils are nrmly responding towards light ,no history of fever, neck rigidity,head injury

Embolism??? Pregnant??

Loss of vision in both eyes? Or one eye? And also BP? Ocular pain?

Diseases Related to Discussion

Multiple Sclerosis
Neuromyelitis Optica
Optic Neuritis
Hypertensive Retinopathy

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