Approach to acute vision loss Quiz: Ace Your Exams

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A 71-year-old man is brought to the emergency department by his partner for evaluation of vision loss and right arm weakness. The patient and his partner were playing tennis three hours before arrival when the patient said he was not able to see the ball coming from the right side of the court. He could still see the left side of the net and the center with the affected eye. He then developed weakness in his right arm and could not hold his racket. Past medical history is significant for hypertension, hyperlipidemia, and diabetes mellitus. Medications include lisinopril, atorvastatin, and metformin. Temperature is 37.0°C (98.6°F), pulse is 78/min, respirations are 12/min, and blood pressure is 130/85 mmHg. There is a relative afferent pupillary defect in the right eye. He has homonymous hemianopsia involving the medial side of the right eye and the temporal side of the left eye. A small central area of vision is preserved in both eyes. Muscle strength in the right arm is 3/5, and it is 5/5 in the left arm. What additional testing is most likely to confirm the diagnosis?

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Magnetic resonance imaging (MRI) of the orbits without contrast

Magnetic resonance imaging (MRI) of the brain without contrast

Hypercoagulability testing

Electroencephalogram (EEG)

Visual evoked potentials