Too much of a good thing.

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.