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CASE REPORT
Year : 2020  |  Volume : 68  |  Issue : 11  |  Page : 2605-2607

Double trouble with the disc - Hickam's dictum versus Occam's razor!


1 Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
2 Department of Neuro Ophthalmology, Sankara Nethralaya, Medical Research Foundation, Chennai, India

Correspondence Address:
Dr. Sujatha V Kadambi
Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, Medical Research Foundation, Chennai-600006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_825_20

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Differentiating glaucomatous and non-glaucomatous optic neuropathy can be challenging even to an experienced clinician and it is even more complex to identify early ophthalmic manifestation of neurological lesions when the optic nerve is already jeopardized by advanced glaucoma. This is a case of a patient with juvenile open-angle glaucoma with advanced glaucomatous cupping who developed an intracranial tuberculoma and subsequent obstructive hydrocephalus. Subtle edema identified in an almost totally damaged nerve, coupled with a history of headache and tinnitus, was the clinching factor prompting early treatment in the form of ventriculoperitoneal shunting and antituberculous therapy. Detailed history, systematic clinical exam, and appropriate imaging are imperative in reducing morbidity and sometimes mortality associated with these neurological conditions.


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