A 62-year-old patient came to the emergency department complaining of loss of vision in the left eye (OS), without ocular pain, headache, or other accompanying neurological symptoms.
The visual acuity (VA) was 1 in right eye (OD) and 0.1 in OS, with a left relative afferent pupillary defect.
Funduscopic examination revealed superior sectoral oedema in the RE and diffuse papillary oedema with peripapillary retinal haemorrhages.
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The visual field examination was normal in the RE, showing a diffuse severe defect in the LE.
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Blood pressure, erythrocyte sedimentation rate and blood tests were normal, except for an increase in serum fibrinogen, so treatment with acetylsalicylic acid was started.
The hematological and neurological study performed was completely normal.
At 3 weeks the patient came back to the emergency department for sudden loss of vision in the RE, with a reduction of VA to 0.3.
Funduscopic examination showed more pronounced and diffuse edema of the RE, with presence of peripapillary flame hemorrhage.
Perimetry detected an arched defect in the lower hemifield.
Two months after the onset of symptoms, the papilledema had resolved in both eyes (OS), VA being 0.6 in RE and 0.2 in LE.
Optical coherence tomography revealed a significant thinning of the nerve fiber layer 270° in OU.
