History of Presenting Illness in Neuro-Ophthalmology

Update item information
Identifier history_of_presenting_illness
Title History of Presenting Illness in Neuro-Ophthalmology
Subject History; Diagnosis
Creator Andrew G. Lee, MD, Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, TX, Professor of Ophthalmology, Weill Cornell Medicine; Rick Mukhopadhyay, Baylor College of Medicine, Class of 2023
Description Summary: • The HPI is taught to medical students through the mnemonic OLDCARTS: o This method gathers information regarding the onset, location, duration, characteristics, associated symptoms, radiation, timing, severity of symptoms (from 1 to 10), and aggravating and relieving symptoms of the chief complaint. • As a medical student it is good to have a consistent framework when approaching the history of present illness; however, OLDCARTS can be modified to be more effective o We prefer to hear about every doctor and every visit from the time that the patient was last well to the current day o There is something before the manifestation of the chief complaint that is important in establishing the differential diagnosis; o; We want to start the history of present illness from when the patient was last well. • Case 1: 20-year-old white female presenting with acute unilateral loss of vision, pain with eye movement, RAPD, and a normal fundus. o We know this case is headed towards optic neuritis but if we start the case from when the patient was last well, we get a different story. • Case 2: 20-year-old female presented 4 weeks prior with new onset of hiccups, nausea and vomiting, had symptomatic sleep attacks consistent with narcolepsy, has vision loss, pain with eye movement, RAPD, and a normal fundus o Now the differential moves from optic neuritis towards neuromyelitis optica (NMO) o NMO patients often have disease before the vision loss o Area postrema involvement and other aquaporin forage areas cause non-demyelinating like symptoms and it is difficult to suspect a demyelinating disease without starting from when the patient was last well. • Case 3: 80-year-old white female presenting with acute, unilateral loss of vision to no light perception. She has a relevant afferent pupillary defect and a normal fundus. o This is retrobulbar optic neuropathy not form optic neuritis but from ischemic optic neuropathy -This is called posterior ischemic optic neuropathy because we don't see the disc edema o The symptoms will have started before the vision problem. Examples: -jaw pain when they chew their food -scalp tenderness, headache -polymyalgia rheumatica
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2019-10
Format video/mp4
Rights Management Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s61w05hk
Setname ehsl_novel_lee
Date Created 2019-10-10
Date Modified 2019-10-15
ID 1469299
Reference URL https://collections.lib.utah.edu/ark:/87278/s61w05hk
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