ABSTRACT
A 32-year-old Caucasian man has presented to the emergency eye clinic with blurred vision. It has worsened over the past two days and has been accompanied by severe headache for a week. He has also been suffering from frequent intermittent headaches over the past year. These are generalized and tend to occur at any time through the day, with no association with eye symptoms until now. He has no history of epilepsy, muscle weakness, dizziness, hearing loss or weight loss. His blurred vision is worst in the left eye.
Examination This man looks well. His cardiorespiratory and abdominal examinations are unremarkable. Examination of the eyes reveals intact visual fields and eye movements. Visual acuity is 6/6 in the right eye and 6/24 in the left. There is enlargement of the blind spot. Direct ophthalmoscopy shows bilateral papilloedema. There is a cotton-wool spot over the left macula and multiple flame haemorrhages. There are no other cranial or peripheral nervous system defects. His blood pressure is persistently 260/140 mmHg, measured sitting.
