A 65-year-old previously healthy woman noticed new-onset, gradual, blurry vision in her left eye with perceived loss of peripheral vision and pulsatile tinnitus in the left ear for the past 2 weeks. In the past year, she visited 3 different emergency departments for new nonpulsatile and nonthunderclap headaches, which she described as "searing" pain. The headaches were accompanied by nausea without phonophobia or photophobia, were not worsened or triggered by recumbency and Valsalva, and did not wake her from sleep. There were no associated neurologic or systemic symptoms. A noncontrast CT scan of the brain was interpreted as normal. Visual acuity was 20/25 bilaterally. There was no relative afferent pupillary defect. On ophthalmoscopy, she had bilateral severe optic nerve head edema (Figure, A). Formal visual field testing (Humphrey 24-2) showed enlargement of the blind spots in each eye (Figure, B). The remaining neurologic examination was normal.

一名 65 岁以前健康的女性在过去 2 周内注意到她的左眼出现新的、逐渐的、模糊的视力，并伴有周边视力丧失和左耳搏动性耳鸣。在过去的一年里，她因新发的非搏动性和非雷击样头痛到 3 个不同的急诊科就诊，她将其描述为“灼痛”疼痛。头痛伴有恶心，没有声音恐惧或畏光，卧床和 Valsalva 没有加重或触发，也没有把她从睡梦中唤醒。没有相关的神经或全身症状。大脑的非增强 CT 扫描被解释为正常。双侧视力为 20/25。无相对传入性瞳孔缺陷。在检眼镜检查中，她有双侧严重的视神经乳头水肿（图，A）。正式视野测试（Humphrey 24-2）显示每只眼睛的盲点扩大（图 B）。其余神经系统检查正常。