Saturday, September 15, 2018

Blurring of vision on forward bending of the head

Q: Blurring of vision on forward bending of the head is a sign of? 

A) a migraine headache 
B) pituitary mass
C) optic neuritis 
D) raised intracranial pressure (ICP) 
E) pheochromocytoma

Answer: D

Blurring of vision on forward bending of the head should prompt a physician to think of high ICP, particularly if it improves with sitting up (or waking up in the morning), or if associated with double vision or loss of coordination and balance. This is a significant point to learn as the foremost and the first step in the management of increased ICP is to elevate the head of the bed. 

A migraine headache comes in various forms and flavors and literature is so vast that it is beyond the scope of this pearl. But it usually does not get worse with forward bending or improves with sitting up (choice A). 

Pituitary mass usually presents with a visual defect (choice B). 

Optic Neuritis is marked by painful, monocular visual loss (choice C). 

Pheochromocytoma carries systemic signs of generalized sweating, tachycardia, and paroxysmal hypertension (choice E).


References / further read: 

1. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, et al. Guidelines for the management of severe traumatic brain injury. VII. Intracranial pressure monitoring technology. J Neurotrauma 2007; 24 Suppl 1:S45. 

2.  Hainer BL, Matheson EM. Approach to acute headache in adults. Am Fam Physician 2013; 87:682. 

3.  Dodick D. Headache as a symptom of ominous disease. What are the warning signals? Postgrad Med 1997; 101:46.

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