RT Journal Article
SR Electronic
T1 Chronic optic disc swelling overlooked in a diabetic patient with a devastating outcome
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr0620091975
DO 10.1136/bcr.06.2009.1975
VO 2010
A1 Tasanee Braithwaite
A1 Gordon T Plant
YR 2010
UL http://casereports.bmj.com/content/2010/bcr.06.2009.1975.abstract
AB We present a case of asymmetrical but bilateral, progressive, painless visual deterioration over 5 years to no perception of light, in a 61-year-old male diabetic patient referred for a second opinion. The patient had a chronic history of bilateral diabetic maculopathy and unexplained swelling of the optic discs. He was diagnosed with optic atrophy secondary to pseudotumour cerebri (termed idiopathic intracranial hypertension when underlying causes have been excluded), which was associated with obstructive sleep apnoea. The case highlights the critical importance of identifying and investigating chronic papilloedema for reversible causes; the sometimes subtle presentation of pseudotumour cerebri; and the vital role of visual field testing and diagnostic lumbar puncture for timely diagnosis. It also reminds us that chronic bilateral optic disc swelling is not a normal feature of diabetic eye disease, and that alarm bells should sound if reduced visual acuity seems disproportionate to the degree of maculopathy.