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blurred vision

Practice targeted AMC-style multiple-choice questions on blurred vision.

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neurologyelderly patientheadacheaneurysmdifferential diagnosisembolizationimagingmultiple sclerosisophthalmologyoptic neuritis
Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda — CC BY 2.0 · Source

A 68-year-old male presents with worsening headaches and blurred vision. He underwent endovascular coiling for a posterior cerebral artery aneurysm 6 months ago. The attached image was obtained. Which of the following is the MOST appropriate next step in management?

A. Increase the dose of his antihypertensive medication
B. Initiate aspirin therapy
C. Repeat angiography
D. Order a CT scan of the head without contrast
E. Reassure the patient and schedule a follow-up appointment in 6 months
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda — CC BY 2.0 · Source

A 68-year-old male presents with worsening headaches and blurred vision 3 months post-embolization. The attached image was obtained. Which of the following is the MOST appropriate next step in management?

A. Order an MRI of the brain to rule out other causes of headache
B. Initiate a course of high-dose corticosteroids
C. Refer for surgical clipping of the aneurysm
D. Repeat angiography to assess for recanalization
E. Prescribe analgesics and schedule a follow-up appointment in 6 months
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A 24-year-old lady presents with worsening right eye 'ache' and reduced vision. The symptoms worsen with eye movements, and there is no redness or fluorescein uptake. Her vision is 6/12 in the right eye and 6/6 in the left eye. There is a relative afferent pupillary defect (RAPD) on examination. What associated disease could this indicate?

A. Neuromyelitis optica
B. Graves’ disease
C. Multiple sclerosis
D. Ischemic optic neuropathy
E. Sarcoidosis
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