Optic neuropathy quiz - Neuro-Ophthalmology

A 30-year-old obese woman with headaches has a visual acuity of 20/400 OD and 20/80 OS. There is a right RAPD. What is the most likely diagnosis?

Idiopathic intracranial hypertension

Bilateral optic neuritis

Giant cell arteritis

Buried optic disc drusen

Visual function is the best way to differentiate papilledema and bilateral optic neuropathies. This patient has reduced vision function (reduced visual acuity and an RAPD), suggesting there is a bilateral optic neuropathy. If this was papilledema, the patient should have normal visual function.

Which patient has a better visual prognosis after surgery?

Patient A since the bitemporal hemianopia is less dense

Patient A since there is less compression of the optic chiasm

Patient B since there is less involvement of the cavernous sinus

Patient B since the RNFL and macular GCC is better preserved

Pre-operative thickness of the retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) is the best predictor of visual recovery after surgery for patients with compressive optic neuropathies.

What is the most common infectious cause of this presentation?

Lyme disease

Bartonella henselae

Syphilis

Tuberculosis

Bartonella henselae is the principal etiologic agent of cat scratch disease and the most common infectious cause of neuroretinitis. It is a slow-growing, gram-negative bacterium.