Case No. 110

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Case No. 110

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Chief Complaint:

Painless, transient vision loss

Published: Sept. 16, 2017
Case No. 110
Author: ppwei
CASE SCENARIO

A 67 year old male with a medical history notable for hypertension, hyperlipidemia, diabetes, and presents to the ED complaining of transient vision loss to his left eye. The patient states that approximately 3 times in the past 2 years, he has experienced what he describes as a dark curtain over his vision that lasts for 1 minute, then resolves. He denies eye pain when this happens. He reports that his visual acuity has gradually declined over the past several years, which he attributes to aging, but he is still functional and independent. He does not see his primary care provider regularly due to a busy schedule. He denies any other symptoms. His vital signs are T: 37.0 HR: 88 BP: 168/92 RR: 12 SpO2: 99%. His fundal exam is notable for some cotton wool spots and arteriovenous nicking. His neurologic exam is unremarkable. The patient's EKG and basic labs are unremarkable.

QUESTION

What is the next best imaging study?

CT head with and without contrast
MRI of the left orbit
Trans-thoracic echocardiography
Bilateral carotid doppler ultrasound
CT angiography of the chest