Lost in the Sauce

A 41-year-old male was referred to Neuro-ophthalmology for 'pseudotumor cerebri and hypertensive retinopathy' and decreased vision. Three months prior the examination, the patient reported a fairly rapid painless decline in the vision in both eyes over a week. He also reported heavy polysubstance abuse (1L cognac, 1 pack cigarettes, marijuana use daily), and had prior diagnoses of alcoholic cirrhosis and hypertension. Review of systems was positive for weight loss, abdominal pain, recurrent hematemesis, myalgias, paresthesias, frequent falls, peripheral neuropathy, and depressed mood.