LESIONS

A Guide to Localisation in Neurology

Painful visual loss

Case

A 23 year old man developed visual loss in the left eye.

He first noted blurring of the vision, which progressed over several days to the point where he could barely see at all, mainly seeing ‘shadows’ and the outlines of moving objects. He also reported that he had struggled to perceive colours in the left eye as this problem was developing. He had a mild headache around the left temple, and he had discomfort if he moved the eye. His right eye was intact.

He had no prior medical history and no previous neurological or visual symptoms.

On examination he had:

• A normal pupil in the brightly lit room
• In the dark, the pupil dilated
• When the light was shone in the right eye, both pupils would constrict.
• When the light was shone in the left eye, both pupils would constrict, but only partially
• When quickly swung between each eye, the pupils would constrict when the light was shone in right eye, but partially dilate when the light was shone in the left eye
• The left optic disc appeared swollen
• Visual acuity was limited to hand movements in the left eye and was normal in the right eye