Delayed Ophthalmology Treatment Causes Patient To Go Blind

Case Overview

This case involves a 36-year-old male patient who presented to his primary care physician with headaches. The patient was found to have papilledema optic disc swelling caused by intracranial pressure. The patient was immediately referred to a neuro-ophthalmologist for further review. The neuro-ophthalmologist discovered that the patient had CSF opening pressure and diagnosed the patient with idiopathic intracranial hypertension. In spite of this diagnosis, the nuero-ophthalmologist did not initiate the acetazolamide treatment soon enough and the patient eventually became blind in both eyes as a result. An expert in ophthalmology was sought to review the records and opine on the standard of care.

Questions to the Ophthalmology expert and their responses

What steps would you take in order to manage a patient with IIH?

The most important step is to make certain that the CSF formula is normal. If complete CSF studies are not done then repeat the LP. I would begin acetazolamide at a dose of 500 mg q am of the extended release type (specific generic medications would be requested). If only plain diamox is available, then I would prescribe a 250 mg bid and after 4 days increased to 250 mg q 6 hrs. The patient would be contacted in 7 days regarding their headache, pulsatile tinnitus, and/or any visual obscurations. If these symptoms persist, the dose would be increased to 500 mg ER q12 hrs or if plain diamox is available, 500 mg q 6 hrs. I would typically reevaluate the patient after 6 to 8 wks (visual fields OCT and dilated fundus exam) and adjust dose accordingly. The next visit thereafter would occur after 3 months. Lab values should be checked while the patient is taking diamox. The patient should have an earlier visit if they experience persistent or increasing symptoms.

About the expert

This board-certified expert with over 30 years of experience earned his BA from The Johns Hopkins University as well as his PhD and MD from Mount Sinai School of Medicine of CUNY. He went on to complete an internship in internal medicine at Presbyterian University of Pennsylvania Medical Center, a residency in neurology at University of California San Francisco, and fellowship in neuro-ophthalmology from the National Eye Institute. He remains active in the field as a member of the American Academy of Neurology, Society for Neuroscience and North American Neuro-Ophthalmologic Society. This expert has written and lectured extensively on neurological matters and has explored the neurophysiology of brainstem function as basic science researcher for over 25 years. This expert previously worked as a staff physician of neurology at Newington Veterans Administration Medical Center, assistant professor of neurology at the University of Connecticut and an associate professor of neurology at the University of Connecticut Health Center. Currently, the expert is a professor of neurology at a CT university health center.

E-079532

Specialties:

Ophthalmology

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.