Differential Diagnosis for Positional Loss of Vision and Elevated ANA
- Single most likely diagnosis
- Giant Cell Arteritis (GCA): This condition is a large vessel vasculitis that can cause positional loss of vision due to ischemic optic neuropathy. An elevated ANA can sometimes be seen in GCA, although it is not a specific marker. The combination of symptoms and elevated ANA makes GCA a strong consideration.
- Other Likely diagnoses
- Systemic Lupus Erythematosus (SLE): SLE is an autoimmune disease characterized by a positive ANA. It can cause a variety of ocular symptoms, including vision loss, although positional loss of vision is less common. Other systemic symptoms would likely be present.
- Antiphospholipid Syndrome (APS): APS is another autoimmune condition that can cause vision loss, including amaurosis fugax (transient monocular vision loss), which might be positional. Elevated ANA can be seen in APS, especially in the context of SLE.
- Do Not Miss diagnoses
- Temporal Arteritis with Polymyalgia Rheumatica (PMR): Similar to GCA, temporal arteritis can cause vision loss, but it is often accompanied by PMR symptoms like shoulder and hip pain. Missing this diagnosis could lead to permanent vision loss.
- Central Retinal Artery Occlusion: This is an ophthalmologic emergency that can cause sudden, painless loss of vision, which might be perceived as positional. It requires immediate treatment to restore vision.
- Rare diagnoses
- Susac Syndrome: A rare autoimmune endotheliopathy that affects the brain, retina, and inner ear, causing vision loss among other symptoms. It is characterized by microangiopathic changes and could present with positional vision loss, although it is much less common than other diagnoses listed.
- Eales Disease: A rare idiopathic condition causing retinal vasculitis and vision loss, typically in young adults. While it could potentially cause positional vision loss, it is less likely to be associated with an elevated ANA.