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Too much of a good thing.

Danny Varghese1, Dina Abdelsalam2, Safa Ibrahim2

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A patient with diabetes experienced sudden vision loss. Optic nerve swelling and paleness mimicked Foster Kennedy syndrome but were diagnosed as bilateral non-arteritic anterior ischemic optic neuropathy (NAION).

Keywords:
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Area of Science:

  • Ophthalmology
  • Neurology
  • Endocrinology

Background:

  • A 38-year-old male with type 2 diabetes mellitus and hypertension presented with acute vision loss.
  • Ophthalmic findings included optic disc edema (ODE) in the left eye and optic disc pallor (ODP) in the right eye.
  • Severe nonproliferative diabetic retinopathy and cystoid macular edema were present bilaterally.

Purpose of the Study:

  • To investigate the cause of vision loss in a patient with diabetes and hypertension.
  • To differentiate between Foster Kennedy syndrome and other optic neuropathies.
  • To determine the etiology of unilateral optic disc edema and contralateral optic disc pallor.

Main Methods:

  • Clinical ophthalmic examination.
  • Neuroimaging (MRI/CT) and systemic evaluation.
  • Differential diagnosis of optic neuropathies.

Main Results:

  • The patient presented with unilateral acute vision loss, optic disc edema, and contralateral optic disc pallor.
  • Initial suspicion of Foster Kennedy syndrome due to intracranial mass was ruled out by neuroimaging.
  • The final diagnosis was pseudo-Foster Kennedy syndrome, attributed to bilateral non-arteritic anterior ischemic optic neuropathy (NAION), with prior unrecognized NAION in the right eye and acute NAION in the left eye.

Conclusions:

  • Unilateral optic disc edema with contralateral optic disc pallor in a diabetic patient can represent pseudo-Foster Kennedy syndrome.
  • Non-arteritic anterior ischemic optic neuropathy (NAION) should be considered in the differential diagnosis, even with atypical presentations.
  • Prompt and thorough diagnostic evaluation is crucial for accurate diagnosis and management of optic neuropathies.