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BMJ Case Rep. 2010; 2010: bcr06.2009.1975.
Published online Mar 23, 2010. doi:  10.1136/bcr.06.2009.1975
PMCID: PMC3027775
Reminder of important clinical lesson
Chronic optic disc swelling overlooked in a diabetic patient with a devastating outcome
Tasanee Braithwaite1 and Gordon T Plant2
1Chelsea and Westminster Hospital, Ophthalmology, 369 Fulham Rd, London SW10 9NH, UK
2The National Hospital for Neurology and Neurosurgery, Neuroophthalmology, Queen Square, London WC1N 3BG, UK
Correspondence to Tasanee Braithwaite, tasaneebraithwaite/at/gmail.com
Abstract
We present a case of asymmetrical but bilateral, progressive, painless visual deterioration over 5 years to no perception of light, in a 61-year-old male diabetic patient referred for a second opinion. The patient had a chronic history of bilateral diabetic maculopathy and unexplained swelling of the optic discs. He was diagnosed with optic atrophy secondary to pseudotumour cerebri (termed idiopathic intracranial hypertension when underlying causes have been excluded), which was associated with obstructive sleep apnoea. The case highlights the critical importance of identifying and investigating chronic papilloedema for reversible causes; the sometimes subtle presentation of pseudotumour cerebri; and the vital role of visual field testing and diagnostic lumbar puncture for timely diagnosis. It also reminds us that chronic bilateral optic disc swelling is not a normal feature of diabetic eye disease, and that alarm bells should sound if reduced visual acuity seems disproportionate to the degree of maculopathy.
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