Headache and Visual Disturbance

Author: Mohammad Saleki / Editor: Nick Tilbury / Codes: / Published: 06/10/2023

A 70-year-old female presents to the emergency department (ED) with a complaint of headache and pain in her left temple for the past week. She reports that the pain is severe and constant and is associated with scalp tenderness and jaw pain when she eats. The patient also reports that her vision has been blurry in her left eye for the past day.

She denies any recent trauma and has no history of diabetes, hypertension, or thyroid disease. She is on aspirin and atorvastatin.

The patient denies any changes in her hearing, speech, or balance. She reports no chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhoea, recent fever, chills, or night sweats.

On examination, her vital signs are within normal limits. Her visual acuity is 6/18 in the left eye and 6/6 in the right. The pupils are equal and round but you note she has a left relative afferent pupillary defect (RAPD).

On fundoscopy, the left optic nerve appears swollen with a hyperaemic disc. The anterior and posterior segments all appear normal.

Examination is otherwise unremarkable.

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