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FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note U. Schiefer, W. Schnerring, R. Burth, J. Schiller, J. Pätzold, M. Grigoleit,

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Presentation on theme: "FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note U. Schiefer, W. Schnerring, R. Burth, J. Schiller, J. Pätzold, M. Grigoleit,"— Presentation transcript:

1 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note U. Schiefer, W. Schnerring, R. Burth, J. Schiller, J. Pätzold, M. Grigoleit, B. Selig, B. Hart Ophthalmology

2 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Title FR, male adolescent, 18 years old Sudden loss of vision OS, Headache Author: Ulrich Schiefer Translation: Bill Hart

3 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Present History When covering his right eye, Mr R noted a veil over the left eye, and could not see a distant sail boat that was visible with the right eye. Initial diagnosis: Retrobulbar optic neuritis, OS Initial treatment:Oral corticosteroid, 100 mg Qd Rapid weight gain ensued, and Mr R now seeks an alternative therapy.

4 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Ocular History Unremarkable

5 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note General Medical History About 6 weeks ago:Severe upper respiratory infection with a purulent involvement of the right maxillary sinus Obesity otherwise „unremarkable“

6 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Family History No ophthalmic disorders

7 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Social History Student

8 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Other History Unknown

9 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Visual Acuity/Refraction (1/2) Snellen acuity:OD20/15 OS 20/60 Refraction:Not done

10 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Visual Acuity/Refraction - Assessment (2/2)

11 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Color Vision (1/2)

12 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Color Vision - Assessment (2/2)

13 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Ocular Alignment (1/2) Orthophoria

14 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Ocular Alignment - Assessment (2/2)

15 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Stereo Acuity (1/2)

16 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Stereo Acuity - Assessment (2/2)

17 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Motility (1/2) No restriction of eye movements, No apparent diplopia, No pain on eye movement

18 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Motility - Assessment (2/2)

19 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Pupils (1/2)

20 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Pupils - Assessment (2/2) Please mark the correct answer:

21 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Pharmacological Pupillary Tests (1/2)

22 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Pharmacological Pupillary Tests - Assessment (2/2)

23 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Visual Field (1/3) Diagnosis: atypical optic neuritis

24 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Visual Field (2/3) Pituitary Adenoma 30° Visual Field

25 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Visual Field - Beurteilung (3/3) OD:Normal OS:Suggests a temporal hemifield loss

26 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Amsler Grid (1/2) Examination not done

27 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Amsler Grid - Assessment (2/2)

28 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Intraocular pressures (1/2) OD & OS: 16 mm Hg

29 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Intraocular pressures - Assessment (2/2)

30 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Mesoptometry (1/2) Examination not done

31 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Mesoptometry - Assessment (2/2)

32 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Dark Adaptation (1/2) Examination not done

33 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Dark Adaptation - Assessment (2/2)

34 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Other Visual Function Tests (1/2) Examination not done

35 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Visual Function Tests - Assessment (2/2)

36 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Anterior Segment (1/2) Normal, age-consistent findings bilaterally

37 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Anterior Segment - Assessment (2/2) Unknown

38 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Fundus (1/2) ODOS

39 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Fundus - Assessment (2/2) Optic discs have sharp margins and normal color OU - No elevation, hemorrhages, exudates or edema Normal maculas, peripapillary fundus, retinal vessels and retinal periphery in both eyes

40 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Gonioscopy (1/2)

41 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Gonioscopy - Assessment (2/2)

42 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done HRT (1/2)

43 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown HRT - Assessment (2/2)

44 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Optical Coherence Tomography (1/2)

45 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Optical Coherence Tomography - Assessment (2/2)

46 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done GDx (1/2)

47 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown GDx - Assessment (2/2)

48 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Ophthalmometer (1/2) Examination not done

49 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Ophthalmometer - Assessment (2/2)

50 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note HH-Topometry (1/2) Examination not done

51 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown HH-Topometry - Assessment (2/2)

52 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Hertel Exophthalmometry (1/2) Examination not done

53 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Hertel Exophthalmometry - Assessment (2/2)

54 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Other Morphometry (1/2)

55 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Morphometry - Assessment (2/2)

56 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Other Morphology (1/2)

57 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Morphology - Assessment (2/2)

58 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note MRI (1/3) RL

59 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note MRI (2/3) RL Fluid Level

60 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note MRI - Beurteilung (3/3) Hemorrhage into a pituitary adenoma  Fluid-Level Formation!

61 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done CT (1/2)

62 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown CT - Assessment (2/2)

63 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note PET (1/2) Examination not done

64 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown PET - Assessment (2/2)

65 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note X-ray (1/2) Examination not done

66 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown X-ray - Assessment (2/2)

67 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Angiography (1/2)

68 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Angiography - Assessment (2/2)

69 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Fluorescein Angiography (1/2) Examination not done

70 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Fluorescein Angiography - Assessment (2/2)

71 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note ICG Angiography (1/2) Examination not done

72 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown ICG Angiography - Assessment (2/2)

73 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Echography (1/2)

74 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Echography - Assessment (2/2)

75 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Doppler Sonography (1/2) Examination not done

76 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Doppler Sonography - Assessment (2/2)

77 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Echocardiography (1/2) Examination not done

78 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Echocardiography - Assessment (2/2)

79 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Other Imaging (1/2) Examination not done

80 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Imaging - Assessment (2/2)

81 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Pattern VEP (1/2) Examination not done

82 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Pattern VEP - Assessment (2/2)

83 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Flash VEP (1/2) Examination not done

84 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Flash VEP - Assessment (2/2)

85 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Acuity VEP (1/2) Examination not done

86 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Acuity VEP - Assessment (2/2)

87 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Ganzfeld ERG (1/2) Examination not done

88 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Ganzfeld ERG - Assessment (2/2)

89 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note ERG-Campimetry (1/2) Examination not done

90 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown ERG-Campimetry - Assessment (2/2)

91 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Pattern ERG (1/2) Examination not done

92 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Pattern ERG - Assessment (2/2)

93 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note EOG (1/2) Examination not done

94 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown EOG - Assessment (2/2)

95 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Other Elektrophysiologic Tests (1/2) Examination not done

96 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Elektrophysiologic Tests - Assessment (2/2)

97 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done ESR (1/2)

98 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown ESR - Assessment (2/2)

99 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Routine Lab Tests (1/2)

100 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Routine Lab Tests - Assessment (2/2)

101 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Coagulation (1/2)

102 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Coagulation - Assessment (2/2)

103 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Uveitis Serology (1/2)

104 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Uveitis Serology - Assessment (2/2)

105 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Immunopath. Lab Tests (1/2)

106 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Immunopath. Lab Tests - Assessment (2/2)

107 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Differential WBC Count (1/2)

108 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Differential WBC Count - Assessment (2/2)

109 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Other Lab Tests (1/2)

110 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Lab Tests - Assessment (2/2)

111 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Immunopathology (1/2)

112 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Immunopathology - Assessment (2/2)

113 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Histology (1/2)

114 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Histology - Assessment (2/2)

115 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Other Pathology (1/2)

116 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Pathology - Assessment (2/2)

117 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Other Tests (1/2)

118 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Tests - Assessment (2/2)

119 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Internal Medicine Consultation (1/2) Medicine Consult / Endocrinology: Prolactin: 

120 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Internal Medicine Consultation - Assessment (2/2)

121 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Neurology (1/2) Neurological Consult: Months of Galactorrhea

122 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Neurology - Assessment (2/2)

123 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Neurosurgery (1/2) Examination not done

124 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Neurosurgery - Assessment (2/2)

125 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Genetics Consultation (1/2)

126 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Genetics Consultation - Assessment (2/2)

127 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note ENT Consultation (1/2) Examination not done

128 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown ENT Consultation - Assessment (2/2)

129 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Oral and Maxillofacial Surgery (1/2) Examination not done

130 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Oral and Maxillofacial Surgery - Assessment (2/2)

131 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Dermatology (1/2) Examination not done

132 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Dermatology - Assessment (2/2)

133 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Psychiatry (1/2) Examination not done

134 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Psychiatry - Assessment (2/2)

135 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Surgery (1/2) Examination not done

136 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Surgery - Assessment (2/2)

137 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Other Consultations (1/2) Examination not done

138 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Consultations - Assessment (2/2)

139 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Pulse (1/2) Examination not done

140 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Pulse - Assessment (2/2)

141 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note ECG (1/2) Examination not done

142 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown ECG - Assessment (2/2)

143 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Holter Monitor (1/2) Examination not done

144 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Holter Monitor - Assessment (2/2)

145 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Blood Pressure (1/2) Examination not done

146 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Blood Pressure - Assessment (2/2)

147 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note 24 Hour Blood Pressure Monitor (1/2) Examination not done

148 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown 24 Hour Blood Pressure Monitor - Assessment (2/2)

149 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Lumbar Puncture (1/2) Examination not done

150 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Lumbar Puncture - Assessment (2/2)

151 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note CSF Pressure (1/2) Examination not done

152 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown CSF Pressure - Assessment (2/2)

153 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Microbiology (1/2) Examination not done

154 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Microbiology - Assessment (2/2)

155 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Sleep Laboratory (1/2) Examination not done

156 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Sleep Laboratory - Assessment (2/2)

157 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Examination not done Capillarioscopy (1/2)

158 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Capillarioscopy - Assessment (2/2)

159 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Other Findings (1/2) Examination not done

160 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Unknown Other Findings - Assessment (2/2)

161 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Sudden loss of vision OS, headache Primary Symptom

162 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Diagnoses Unknown Your provisional diagnosesActual diagnoses 1 Pituitary-apoplexy (Hemorrhage into a prolactinoma) 2 Obesity 3 Upper respiratory infection with purulent maxillary sinusitis, right side

163 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Differential Diagnoses Your differential diagnosesDifferential diagnoses Unknown Retrobulbar Optic Neuritis (but: lacking pain on eye motion, and atypical sequence of events)

164 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Etiology/Pathogenesis Rapid growth of the tumor increases the risk of pituitary apoplexy  Further reading, see „Clinical NeuroOphthalmology“  Chapter 2  Chapter 3  Chapter 12

165 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Therapy Immediate neurosurgical intervention (after imaging [MRI], including angiography) Use bromocriptine [a dopamine (D2) antagonist] to reduce the level of prolactinemia and shrink the tumor  Introduce with a gradually increasing dose.

166 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Historical Background Wilbrand HL (1926) Schema des Verlaufs der Sehnervenfasern durch das Chiasma. Z Prakt Augenheilkd 59: Wilbrand H, Saenger A. Die Neurologie des Auges. Verlag von J.F. Bergmann, Wiesbaden, 1904.

167 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Hollenhorst RW, Young BR: Ocular manifestations produced by adenomas of he pituitary gland: Analysis of 1000 cases. In: Diagnosis and treatment of pituitary tumors. Editors: Kohler PO, Ross GT, pp Excerpta Medica, Amsterdam, 1904 Huber A (1977) Chiasmasyndrome - Klinik. Klin Monatsbl Augenheilkd 170: Horton J. In: Hoyt WF, ed. An Update in Neuro-Ophthalmology. UCSF, San Francisco, California, 1995: pp Schiefer U, Isbert M, Mikolaschek E, Mildenberger I, Krapp E, Schiller J, Thanos S, Hart W (2004) Distribution of scotoma pattern related to chiasmal lesions with special reference to anterior junction syndrome. Graefes Arch Clin Exp Ophthalmol 242: Literature

168 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note The optic chiasm is the locus of the greatest risk for catastrophic loss of vision. Chiasmal lesions produce characteristic visual field deficits that show respect for the vertical meridian (in at least one eye) and can be monocular or binocular with widely varying asymmetries. Rapid growth of the tumor increases the risk of pituitary apoplexy. Summary

169 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Cost Analysis xxxx Sum: 0 xxxx Total time: 0s Medical treatmentTimeCosts Cost estimation according to GOÄ

170 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Optimal Approach xxxx Sum: 0 Cost estimation according to GOÄ Medical treatmentCosts

171 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Comparison xxxx Your approach: Optimal approach:

172 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note xxxx Evaluation of Questions

173 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Other Discussion Unknown

174 FR, Male adolescent, 18 years old Sudden loss of vision OS, headache Note Template


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