A 23-Year-Old With Blindness After a Fall She Can't Remember

Jeffrey S. Forrest, MD; Alexander B. Shortridge

Disclosures

November 27, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 23-year-old woman is brought to the emergency department by her concerned mother after experiencing an apparent fall. The patient's mother reported that she found the patient early that morning. The patient was lying on the floor of the bathroom staring blankly at the ceiling.

The patient recounted that she had had fallen asleep several hours earlier while studying for her exams and woke up needing to urinate. She stated that she could not remember what happened after this time. She was unable to get up without assistance from her mother. The patient downplayed her fall and had to be convinced by her mother to come to the emergency department. The patient mentioned that she might have bumped her head on the bathroom sink during the fall, but she reported no pain and did not lose consciousness. She also nonchalantly reported that she could not see out of her left eye and described lower-extremity weakness, also on her left side.

When questioned about her medical history, the patient only reported that she has occasional migraines for which she takes sumatriptan. Her mother contributes that her daughter also takes alosetron for irritable bowel syndrome and fluoxetine for depression.

The patient appeared to be noticeably unworried about her condition. Her mother mentioned that her daughter has experienced numerous significant life stressors recently, including her father's recent diagnosis of terminal glioblastoma multiforme and increasing pressure from her rigorous nurse practitioner program. When questioned about this, the patient minimized her current situation, simply stating, "I have my ups and downs." The patient denied suicidal ideation, plans, gestures, or intention.

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