![]() ![]() Investigations may include CBC, ESR, CRP, TSH, PT, INR, fasting lipid profile, serum glucose, and HbA1c. ![]() The corresponding clinical signs should be sought in the physical examination which should also include ophthalmoscopy, visual acuity, and color vision testing. The monocular or binocular nature of the symptoms and association with painful eye movements, diplopia, ptosis, bulbar dysfunction, jaw or tongue claudication, and constitutional symptoms are helpful in narrowing the differential diagnosis. The history should provide details on the time of onset and the course of progression in addition to details of the type of visual phenomena experienced. Patients are usually hemodynamically stable. These are usually seen in conditions like stroke, multiple sclerosis, and neuromyelitis optica. ![]() Negative phenomena comprise blindness, visual field deficits or scotomas, decreased visual acuity, and color blindness or desaturation. These are usually seen in patients with migraine or epilepsy. Positive phenomena includes the perception of light flashes, bright spots, scintillating scotomas, photopsia, phosphenes, and zigzag lines starting small and enlarging with fortifications (fortification spectra). The visual symptoms may be either a positive or a negative phenomenon. Most patients referred to neurology service for visual disturbances have a chief complaint of blurred vision, double vision, or acute loss of vision. ![]()
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