MCQ – 88309

A 27-year-old woman comes to the physician for the evaluation of blindness in her right eye that suddenly started 1 hour ago. She has no feeling of pain, pressure, or sensation of a foreign body in the right eye. She has a history of major depressive disorder treated with fluoxetine. The patient attends college and states that she has had a lot of stress lately due to relationship problems with her partner. She does not smoke or drink alcohol. She does not use illicit drugs. She appears anxious. Her vital signs are within normal limits. Ophthalmologic examination shows a normal-appearing eye with no redness. Slit lamp examination and fundoscopy show no abnormalities. A visual field test shows nonspecific visual field defects. An MRI of the brain shows no abnormalities. Which of the following is the most likely diagnosis?

Correct Answer � D Explanation

Conversion disorder

Acute stress disorder

Acute stress disorder is a condition that develops after a traumatic event and manifests with symptoms such as anxiety, intrusive thoughts, and negative mood that last between 3 days and 1 month. This condition does not cause somatic manifestations (e.g., blindness).

Somatic symptom disorder

Somatic symptom disorder is a condition in which a patient has persistent somatic symptoms (e.g., headache, fatigue) that result in excessive thoughts and/or behaviors that disrupt daily life. This patient appears anxious and has monocular blindness. However, a diagnosis of somatic symptom disorder requires symptoms to persist for = 6 months.

Optic neuritis

Optic neuritis can cause sudden, monocular vision loss. However, this patient does not have other typical manifestations of this condition such as periocular pain, an afferent pupillary defect, or a fundoscopic examination that shows hyperemia and swelling of the optic disc. In addition, optic neuritis typically causes optic nerve inflammation that is visible on MRI.

Conversion disorder

This patient has conversion disorder, a condition that manifests with neurologic symptoms that are inconsistent with neurologic disease. She presents with unilateral blindness but has an ophthalmologic examination and MRI that do not indicate an underlying neurologic etiology. Conversion disorder is more common among young women who have a comorbid psychiatric condition and typically develops after an acute stressor (e.g., trauma, interpersonal conflict). The diagnosis of this condition requires thorough evaluation and ruling out of other possible diagnoses, such as retinal detachment in this patient with sudden, painless, monocular vision loss.