Visual phenomena, decreased vision secondary to occipital lobe infarct
A 72-year-old white male presented with the report of experiencing two red lights shining into his eyes. This was episodic and first occurred two days earlier. He further reported that “half” of the vision was missing in each eye. This was more apparent when he looked at a clock. He added that his left eye had cleared, but his right eye remained somewhat blurry.
His contributory ocular history as a previous patient (2003–2010) included strabismic amblyopia (35 RT hypertropia OD), and a shotgun injury to forehead during a live-fire training as a teenager with some shrapnel remaining. He relocated in 2010.
One year ago, he suffered a stroke affecting the left side of his face. Bell’s palsy was ruled out. A CT scan was inconclusive for infarct; he did not receive an MRI due to the buckshot in forehead). Tests were performed elsewhere.
Previously from Dr. Semes: The case of the disappearing drusen
His current medication history is extensive and remarkable for hypothyroidism, hypertension, hypercholesterolemia and heart disease.
• Diltiazem-ER 240 mg/d
• Nexium (esomeprazole, AstraZeneca) 40 mgqd
• Synthroid (levothyroxine sodium, Abbott Laboratories) 200 mcg/d
• Potassium chloride 10MEQ/d
• Lasix (furosemide, Sanofi Aventis) 40 mg bid
• Zocor (simvastatin, Merck) 20 mg HS
• Flonase (fluticasone, GlaxoSmithKline) 0.05% spray 1per nostril qd
• Pradaxa (dabigatran, Boehringer Ingelheim) 150 mg bid
• Digoxin 0.25 mg/d
• Testosterone 200 mg qd
• Finasteride 5 mg three times a week
• Fish oil 1,000 mg bid
• Vitamin B12 1,000 mcg twice a day
• Metamucil once a day
• Self-initiation of 87 mg aspirin two days ago (in addition to the Pradaxa)