Cases for finals #7 – History

33 year old woman

  • painful left eye 5 days ago
  • vision reduced – can see light/dark only in left eye
  • pain behind eye; worse on moving eye
  • last year, had an episode of right leg numbness for 4 weeks; resolved now
  • been feeling really tired lately

What do you think is going on?

What might make the symptoms worse?

To summarise:

“sub-acute, monocular visual loss with retro-orbital pain. Previous, resolved episode of sensory disturbance in the right leg”

This might be one of those pattern recognition stories for some of you. If not, then you have to figure out where the problem is.

Monocular visual loss is anterior to the chiasm – either retinal or optic nerve. I guess the pain is more suggestive of nerve than retina and the fact that is is worse on eye movements again is typical of inflamed optic nerve pain. Inflammation (“Itis”) of the optic nerve is, imaginatively, known as OPTIC NEURITIS.

Now then, why might we have numbness in a leg? Well, could the optic neuritis be part of a wider problem? Seems at least likely.

Did you figure out what might make the symptoms worse? Read the next post to find out…


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