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  • 1.  patient whose help I need

    Posted 04-28-2026 08:18
    I have a 61 year old healthy female with Alopecia who has had at least a 2-3 year history of near complete binasal hemianopia with normal imaging (MRI) and autoimmune workup. She has not had an LP or CSF chemistries.
    Anythoughts.
    Scott Forman, MD


  • 2.  RE: patient whose help I need

    Posted 04-28-2026 08:37
    She has no atherosclerosis of her carotids and was completely unaware of her disability until I pointed it out to her. I have seen her twice and the field defect is real and documented; She has mild dyschromatopsia and some temporal RNFL thinning.
    Scott Forman, MD





  • 3.  RE: patient whose help I need

    Posted 04-28-2026 09:05

    I would do immunology labs to screen any background autoimmune disorders 



    Original Message


  • 4.  RE: patient whose help I need

    Posted 04-28-2026 09:14
    I think you need to localize the lesion before performing a lab investigation, it is unclear if this is retina, optic nerve, or psychologic.

    Some important history is missing:
    Why does a healthy patient who is unaware of visual field loss go to see a neuro-ophthalmologist?
    Any history of head trauma, meningitis?

    Is the RNFL temporal thinning due to nasal shifted peaks or is it real? 
    What does the ganglion cell look like?
    What does the outer retina look like on OCT, auto-fluorescence?
    If both normal, consider full field ERG.

    Is the MRI really normal? Is ther optic nerve T2-hyperintensity or atrophy?

    Best,

    Drew



    Original Message


  • 5.  RE: patient whose help I need

    Posted 04-28-2026 09:24
    Drew definitely right , may things need to be repeated specially MRA brain for example Aneurysm pushing the chiasma against clinoid , but what comes to mind with alopecia and what appears to be a suspected optic nerve affection , that what fist comes to mind , is VKH and autoimmune disorders know of the association 



    Original Message


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