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Quiz: When Words Disappeared

Test your understanding of this case with 10 questions.

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Case Information
Review the case details while answering questions

PATIENT DEMOGRAPHICS

76-year-old male

PRESENTING COMPLAINT

Acute onset difficulty reading. Patient reports 'letters or small words missing' and that 'reading did not make sense'.

EXAMINATION FINDINGS

Visual Acuity: OD: 6/6, OS: 6/6

Pupils: Equal and reactive, no RAPD

Fundus: Normal optic discs and retinal vasculature bilaterally

INVESTIGATIONS

Central Visual Field Testing (Humphrey 10-2): Bilateral central 10-degree perimetry revealed the same scotoma in both eyes, consistent with a left homonymous inferior paracentral scotoma. This localizes to a lesion in the right occipital pole above the calcarine fissure.

Humphrey 10-2 perimetry showing left homonymous inferior paracentral scotoma in both eyes

Humphrey 10-2 perimetry showing left homonymous inferior paracentral scotoma in both eyes

Neuroimaging (CT/MRI Brain): Stroke in right occipital cortex above the calcarine fissure, corresponding to the visual field defect.

Question 1 of 10

A patient presents with acute reading difficulty but VA is 6/6 in each eye and the optic discs appear normal. Which of the following best explains this discrepancy?

Question 2 of 10

What clinical test should be performed next when a patient has normal VA but reading difficulty?

Question 3 of 10

The 10-2 perimetry showed the same defect in both eyes. What does this suggest?

Question 4 of 10

The field defect was a left homonymous inferior paracentral scotoma. Where does this localise the lesion?

Question 5 of 10

This patient initially presented to a general practitioner who checked VA, found it normal, and reassured the patient. What was the critical examination error?

Question 6 of 10

What is the most appropriate next step in management?

Question 7 of 10

What is the most likely diagnosis?

Question 8 of 10

This patient requires urgent neurological referral and stroke work-up.

Question 9 of 10

What is the most likely diagnosis?

Question 10 of 10

The following is an appropriate management step: Urgent neurological referral and stroke work-up