Purpose

The purpose of this assignment is to work through one case at a time of a patient presenting with Transient Visual Loss. The order in which you request information, and your text responses will be and provided to the instructor. The goal of this exercise is to enhance classroom discussion and your answers may be presented in the class as talking points.

How to Complete the Assignment

The assignment requires you to investigate the patient history and additional patient results to determine a differential diagnosis. The elements of the history can be requested in any order you think is appropriate. You will be required to select each element of the history you think is most relevant to the patient’s chief complaint in a step-by-step manner, then you will be given the patient history for your inquiry, and then you will enter a free text response to indicate if the information was helpful in determining your diagnosis, and then you should enter you current differential diagnosis in order of most likely and what causes can be eliminated from your differential at that point in the process. You will then repeat the process to determine other parts of the history that you think are the most relevant, until you are ready to submit your refined differential diagnosis of probable entities, ranked in order of their likelihood. You may enter your differential diagnosis at any time by clicking the "Differential Diagnosis" button. Once the diagnosis is submitted the assignment is complete and no further action is required until attending the lecture, where each case will be discussed as a group interaction.

Materials

You are provided a suggested outline for taking a history from a patient presenting with the symptom of Transient Visual Loss. This can be accessed at any time using the button "Class Materials" .

After the Lecture

You will be provided with a link to review the suggested way to work through the case along with keys points for evaluating each piece of the information from the patient history.

Bilateral vs Unilateral

• Bilateral – Center going out first or periphery going out first
• Unilateral – Which part of the visual field went out – peripheral, first, then central, altitudinal, area of vision spared

Duration

• Seconds
• Minutes
• Hours

Characteristics of the episode (positive or negative phenomena)

• Darkening of vision
• White out of vision
• “Positive” phenomena

What the person was doing at the time

• Coughing or laughing or straining?
• Change in posture
• Sitting at rest
• Rubbing their eye
• Looking at a bright light and then seeing an afterimage
• After eating
• Occurring with exposure to bright daylight
• Palpitations, irregular heartbeat
• Darkness

What is the pattern of the vision loss

• Peripheral field goes out first
• Central field goes out first
• Regional field change such as altitudinal loss

Were there any other symptoms at the time

• Light headedness
• Unilateral weakness or
• Global amnesia or cognitive dysfunction or motor activation