OE
OphthalmoEducate
Back to Case

Quiz: The Cardiac Patient's Vanishing Vision

Test your understanding of this case with 10 questions.

Progress0 / 10 completed
Case Information
Review the case details while answering questions

PATIENT DEMOGRAPHICS

44-year-old male

PRESENTING COMPLAINT

Sudden-onset visual field loss. Patient describes loss of vision in part of the visual field. No eye pain or headache reported. The patient was found to have viral cardiomyopathy on echocardiography performed as part of the stroke workup. Visual acuity was preserved bilaterally at 6/6. Pupils were equal and reactive with no relative afferent pupillary defect.

EXAMINATION FINDINGS

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

Pupils: Equal and reactive, no relative afferent pupillary defect (RAPD)

Fundus: Fundus examination unremarkable bilaterally

INVESTIGATIONS

Automated perimetry showing dense left homonymous hemianopia and subtle right homonymous inferior quadrantic loss

Automated perimetry showing dense left homonymous hemianopia and subtle right homonymous inferior quadrantic loss

Visual Field Testing (Automated Perimetry): Dense left homonymous hemianopia with subtle right homonymous inferior quadrantic loss. The combination of dense hemianopia on one side with subtle contralateral defect suggests bilateral occipital involvement.

MRI Brain: Bilateral visual cortex infarcts in occipital lobes

MRI Brain: Bilateral visual cortex infarcts in occipital lobes

MRI Brain: Demonstrates bilateral occipital cortex infarcts, confirming the clinical localization from visual field testing.

Echocardiography: Viral cardiomyopathy with impaired ventricular function identified as a high-risk source for intracardiac thrombus formation and systemic embolism.

Question 1 of 10

What does the combination of sudden onset and absence of pain suggest about the likely aetiology?

Question 2 of 10

This patient was found to have viral cardiomyopathy on echocardiography during the stroke work-up. Why is characterising cardiac function particularly important here?

Question 3 of 10

The visual field testing showed a dense left homonymous hemianopia with an additional subtle defect on the right side. What is the clinical significance of finding defects on both sides?

Question 4 of 10

In addition to the dense left hemianopia, what subtle defect was detected?

Question 5 of 10

Why does a right occipital lesion cause left-sided visual field loss, while the left occipital lesion here causes right-sided loss?

Question 6 of 10

Which imaging finding confirmed the diagnosis?

Question 7 of 10

What is the most likely cause of this patient's stroke?

Question 8 of 10

What is the most likely diagnosis?

Question 9 of 10

What is the most appropriate next step in management?

Question 10 of 10

Despite bilateral occipital infarcts, this patient accurately reports and describes his visual field loss. Why is this an important negative finding to document?