History of Present Illness (HPI)
A 64 yo male with a PMH significant for high myopia and DMII presents to the ED due to sudden, painless partial vision loss in the temporal field of his right eye. The patient states that he noticed a shadow in his peripheral vision 3 days ago but when he woke up this morning the shadow was larger and has now moved towards the center of his right eye. He hit his mailbox while leaving his driveway this morning because he didn’t see it in his periphery. Last night he recalls a few brief episodes of “bright flashes of light in his right eye.” He asked his son to drive him to the ED because of his vision loss.
What’s at the top of your differential diagnosis? Choose at least 3 before moving on!
Retinal Detachment
Non-arteritic ischemic optic neuropathy
Arteritic Ischemic Optic Neuropathy (Giant Cell Arteritis Associated)
Retinal Vein Occlusion
Retinal Artery Occlusion
Cerebrovascular Accident
Retinoschisis
Choroidal Mass
Compressive Optic Neuropathy
Amaurosis Fugax
Ocular migraine
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