A 44-year-old obese woman with a medical history of iron-deficiency anemia (pretreatment hemoglobin of 8.8 g/dL) presented with blurred vision in her right eye and new headaches over 1 month. She described the headaches as holocephalic, rated them 4–5 out of 10 (where 1 is minimal intensity and 10 is maximal intensity) without any diurnal or positional variation. She had associated intermittent nausea, but no vomiting. She denied any characteristics consistent with a thunderclap headache. She initially saw her optometrist and was referred to neuro-ophthalmology for bilateral optic disc edema. Examination revealed a visual acuity of 20/30 OD and 20/20 OS, and Humphrey visual field testing showed an enlarged blind spot OD (MD −4.60 dB) and was normal OS (MD −2.10 dB). Slit-lamp examination revealed a posterior subcapsular cataract in the OD and dilated fundus examination showed moderate optic disc edema in both eyes with hemorrhages in all 3 retinal layers in the OD (shown in Fig. ). Her blood pressure was 128/78, and her hemoglobin was found to be 9.0 g/dL with mean corpuscular volume of 70.4 fL. Magnetic resonance imaging/magnetic resonance venography of the head was normal apart from signs of raised ICP, and lumbar puncture showed an opening pressure of 34 cm of water with normal CSF contents. She was started on acetazolamide 500 mg BID and continued her recent supplementation with ferrous fumarate. With significant weight loss, her optic disc edema resolved after 4 months, and she continued to maintain normal visual function. The final Humphrey mean deviation was −2.80 dB OD and −0.72 dB OS.
A 41-year-old man complaining of left visual disturbance visited our department. He had a history of IVH associated with moyamoya disease three months ago. He was comatose at the initial presentation. Computed tomography (CT) at the first visiting hospital demonstrated IVH with hydrocephalus (). Cerebral angiography showed severe bilateral stenosis at the distal internal carotid artery and basal moyamoya vessels. It was compatible with moyamoya disease (). Emergent extraventricular drainage was performed. His mentality gradually improved to alert. Ophthalmologic examination at our hospital detected a vitreous hemorrhage in his left eye (), with right eye remaining normal (). In spite of three months conservative care, his visual acuity was not improved. Vitrectomy with epiretinal membrane removal was performed (). After operation his left visual acuity was recovered.