Emergency Med Case Challenge: A 46-Year-Old Beauty Pageant Winner With Sudden Blindness

Catherine Divingian, MD, PhD; Valerie Gironda, MD, MPH

Disclosures

December 09, 2022

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 46-year-old woman presents to the emergency department (ED) with sudden-onset blindness in her right eye. She states that her vision suddenly diminished that night. All she could discern were vague shadows. The patient confirms sudden unilateral vision loss; however, she reports no fever, headache, tinnitus, eye pain, diplopia, palpitations, chest discomfort, nausea, vomiting, numbness or tingling, loss of sensation, or loss of motor function. She denies any recent trauma.

She has been following up with her primary care physician every year with regular checkups and laboratory tests. She recalls having "slightly elevated" fasting blood glucose and cholesterol levels, although she cannot recall the exact numbers. The patient has been keeping a blood pressure log because she had slightly elevated values in the physician's office a few months ago, with systolic blood pressures of 140-149 mm Hg. However, her systolic blood pressures in the log are in the 120s mm Hg to low 130s mm Hg at home when she is relaxing.

Currently, she is not taking any medication other than an oral contraceptive pill. She has two children who were born at term and delivered vaginally, and she has no history of miscarriages.

Her most recent visit to an optometrist was 2 years ago. The optometrist recommended that she start wearing reading glasses with 2.00 magnification to help with age-related presbyopia. She denies any other vision problems before the current visit.

Her past surgical history includes breast implants at age 18 years when she was actively competing in the beauty pageant circuit. Since then, she has had multiple cosmetic procedures, including face-lifts and abdominoplasty, starting at age 35 years.

The patient does not use tobacco products or illicit drugs. She reports the social use of alcohol, drinking two glasses of wine on the weekends.

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