Year: 1993
Type: article
Abstract: On examination he was well and not overweight.Corrected visual acuity was 6/6 on the right and 6/18 on the left.Colour vision was normal.There was mild constriction of the peripheral visual fields and the blind spots were enlarged, more so on the left.There was bilateral papilloedema, worse on the left, with haemorrhages and retinal and choroidal folds.The remainder of the neurological examination was nor- mal, as was the general examination.The following investigations were normal or negative: full blood count, electrolytes, renal function, liver function, serum glucose, clotting screen, syphilis serology, lupus anticoagulant, protein C and S, antithrombin III, autoantibody screen, monospot, and cold agglutinins.Psittacosis complement fixation test was strongly positive at 1280.A repeat measurement three weeks later was 640.Mycoplasma and Coxiella titres were both < 40.A chest radiograph and CT brain scan were normal.Intravenous digital subtraction angiography showed no occlusion of the major cerebral venous sinuses.At lumbar puncture the opening pressure was elevated at 37 cm; CSF constituents were normal.A total of 20 ml of CSF was drained with symptomatic improvement and he was given a ten day course of oral erythromycin.Two weeks after the initial lumbar puncture the visual symptoms recurred with intermittent diplopia.Mild bilateral sixth nerve palsies were now present and at repeat lum- bar puncture CSF pressure was 37-5 cm.He was started on acetazolamide 250mg twice daily.One week later the CSF pres- sure was 22-5cm and his symptoms and visual fields had improved.The acetazolamide was continued for a further two weeks but then stopped following an episode of suspected renal colic.Despite this he continued to improve and after nine months, although troubled by occasional headaches, visual acuity was 6/6 on the right and 6/9 on the left.The left blind spot remained slightly enlarged but peripheral fields were now normal.There was no swelling of the optic discs and eye move- ments were normal.
Authors: H. Larsson, L. Edstrom, L. Larsson
Language: French
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2045678464