Blurred Disc Margins

We describe a case of a young patient referred to the neuro-ophthalmology clinic with "blurred disc margins bilaterally" and "RNFL thickening." The case focuses on pitfalls associated with workup for this presentation, before revealing the patient's ultimate diagnosis and ongoing management.

UPFRONT Case Section Editor: Larry Frohman, MD Blurred Disc Margins W e describe a case of a young patient referred to the neuro-ophthalmology clinic with “blurred disc margins bilaterally” and “RNFL thickening.” The case focuses on pitfalls associated with workup for this presentation, before revealing the patient's ultimate diagnosis and ongoing management. The case is available to download via the following link: https://journals.lww.com/jneuro-ophthalmology/Documents/JNO%20Upfront%20Cases/UPFRONT% 20Case%2022%20-%20Blurred%20Disc% 20Margins.pptx. Eye Swelling and Decreased Vision in a Patient With Autism O ur UPFRONT case describes an 8-year-old girl with severe autism spectrum disorder who presents with worsening eyelid swelling, decreased vision, and new exotropia for 1–2 months. Examination in the clinic, significantly limited by cooperation, revealed dry eye, and topical cyclosporine was started. Subsequent examination was notable for difficulty walking, needing to feel the area around her feet, and a complete relative afferent pupillary defect (rAPD) on the right. Sedated MRI showed no compressive lesions, but abnormal bone marrow signal was noted. Examination under anesthesia (EUA) revealed conjunctival keratinization, temporal optic nerve pallor, and attenuated retinal vessels with a salt and pepper fundus. Laboratory testing confirmed the final diagnosis of vitamin A and B12 deficiencies (both undetectable in serum; among other deficiencies) secondary to very restrictive eating habits (exclusively chicken nuggets, Cheerios, and fries), which were revealed by more detailed history obtained immediately after the EUA. The patient underwent admission, urgent gastrointestinal (GI) and nutrition consults, and parenteral repletion. The case is available to download through the following link: https://journals.lww.com/jneuro-ophthalmology/Docu- Movie-Like Palinopsia A 62-year-old man presented to the neuro-ophthalmology clinic with intermittent visual disturbances in his left visual field for the previous 13 months. Movie-like episodes of previously seen visual stimuli would play out in his left visual field long after the stimuli were removed. UPFRONT Case: J Neuro-Ophthalmol 2023; 43: e63-64 John O. T. Britton, BMBS Patrick Yu-Wai-Man, PhD, FRCPath, FRCOphth Benson S. Chen, MBChB, FRACP University of Cambridge (JOTB, PY-W-M, BSC), Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust (JOTB, PY-W-M, BSC), Cambridge, the United Kingdom; and Moorfields Eye Hospital NHS Foundation Trust (PY-W-M), London, the United Kingdom. Address correspondence to: John O. T. Britton, BMBS, John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, E.D. Adrian Building, Forvie Site, Robinson Way, Cambridge CB2 0PY, United Kingdom; E-mail: [e-mail] The authors report no conflicts of interest. ments/JNO%20Upfront%20Cases/UPFRONT%20Case% 2021%20-%20Eye%20Swelling%20and%20Decreased% 20Vision%20in%20a%20Patient%20with%20Autism.pptx. Jia Xu, MD Yanjia Jason Zhang, MD Efren Gonzalez, MD Thomas H. Dohlman, MD Eric D. Gaier, MD, PhD Department of Ophthalmology (JX), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Division of Gastroenterology, Hepatology, and Nutrition (YJZ) and Department of Ophthalmology (EG, THD, EDG), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology (THD, EDG), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and Picower Institute for Learning and Memory (EDG), Massachusetts Institute of Technology, Cambridge, Massachusetts. Address correspondence to Eric D. Gaier, MD, PhD, Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115; E-mail: [e-mail] Supported by NIH grants K08 EY030164 (E. D. Gaier) and K08 EY031759 (T. H. Dohlman). The authors report no conflicts of interest. These episodes were consistent with kinetic hallucinatory palinopsia, believed to be secondary to a right anterior occipital lobe infarct causing partial seizures. The case is available to download through the following link: https://journals.lww.com/jneuro-ophthalmology/ Documents/JNO%20Upfront%20Cases/JNO% 20UPFRONT%20Case%2020%20-%20Movie-Like% 20Palinopsia.pptx. e63 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.