Hi colleagues,
I hope everyone is well. Happy belated Mother's Day to the moms. I need help managing with two scenarios if you would be so kind to share your wisdom.
1.) I have an 80 year old F patient who was referred to me (and got to me about 8 weeks after an event) in the right eye. First, she woke up with painless peripheral vision loss. Vision loss was "blackness". Saw retina and turns out to have been a BRAO without embolus. Was non-compliant (I think a mix of dementia and being from out of town) so did not go to the hospital as instructed.
Showed back up to retina a few days later. She experienced gradual graying out of the vision until the entire visual field was black! LP vision :( Was noted to have disc edema. The patient does not have headache jaw claudication or any other symptom. Obviously retina sent immediately to the hospital where a stroke workup was done and ESR CRP normal. Imaging including MRI brain/orbits normall. Retina was so concerned she was started on a small dose of steroids (40 mg PO with taper) and she gets to me 8 weeks later on 10 mg PO pred not having been biopsied. Don't worry- I yelled at the retina doc. ;) On exam the disc is 0.9, pale. OS 0.2 normal.
I sent her to an OP for biopsy who has a ton of experience and he said the artery looks entirely normal and the result of the biopsy was normal.
I'm wondering if you all would treat this as GCA regardless?
(2.) If you have the energy I have a second question:
36 yo M. Long Covid. Very symptomatic visual snow. No migraine but the cognitive fog and memory issues. The snow is one of his most troubling symptoms. He has a lot of resources and has seen Neuro-ophthalmology before elsewhere and has a "team" of doctors addressing the long COVID sequelae. One physician has asked me if I believe the kynurenine pathway has something to do with the snow? Are any of you familiar with this? I'm assuming the answer is no, but I don't think anyone really knows? Thoughts?
Thank you so so much!!
Christine