Headache, Homonymous Hemianopia, Bitemporal Defects and Demyelination

The patient is a 32 year old telephone company employee, who, in March 1978, began to have severe headache, nausea and vomiting and was unable to see to the right. She was seen by a local ophthalmologist who found a right homonymous hemianopsia. Visual acuity was 20/30 in the right eye and 20/50 in the left eye. The rest of her examination was entirely normal. She denied any prior symptoms or other difficulties. CT scan and skull films done at that time were normal and brain scan done 4 weeks after the onset of headache revealed an uptake in the left occipital region. Because she continued to have headache and dizziness, she was referred for evaluation at the University of Iowa Hospitals.