Differential Diagnosis for Visual Disturbance

The patient's complaint of experiencing a "curtain" effect in their right-sided vision when looking from left to center suggests a visual field defect. This symptom can be associated with various neurological and ophthalmological conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Homonymous Hemianopia: This condition, characterized by a visual field defect on the same side of both eyes, is often caused by lesions in the optic tract, lateral geniculate nucleus, or the visual cortex. The description of a "curtain" effect is consistent with the type of visual field loss seen in homonymous hemianopia, which can result from stroke, traumatic brain injury, or tumors affecting the brain's visual pathways.

• Other Likely Diagnoses

  • Optic Neuritis: Inflammation of the optic nerve can cause visual disturbances, including blind spots or loss of vision, which might be perceived as a curtain effect. It's commonly associated with multiple sclerosis but can also be idiopathic or post-infectious.
  • Migraine with Aura: Visual auras in migraines can manifest as zigzag patterns, blind spots, or shimmering lights, which might be interpreted as a curtain effect. These symptoms are usually transient and precede the headache phase of a migraine.
  • Retinal Detachment: Although typically associated with symptoms like flashes of light and floaters, in some cases, retinal detachment can cause a visual field defect that might be described as a curtain descending over the field of vision.

• Do Not Miss Diagnoses

  • Pituitary Adenoma: A tumor in the pituitary gland can compress the optic chiasm, leading to bitemporal hemianopia, but in the early stages or with eccentric lesions, it might cause a variety of visual field defects, including those that could be described as a curtain effect. Missing this diagnosis could lead to delayed treatment and significant morbidity.
  • Stroke: Acute stroke, particularly involving the posterior circulation, can cause sudden visual disturbances, including homonymous hemianopia. Prompt recognition is crucial for timely intervention and prevention of further brain injury.

• Rare Diagnoses

  • Occipital Lobe Seizures: Seizures originating in the occipital lobe can cause visual hallucinations or disturbances, which might be perceived as a curtain effect. These are relatively rare and would typically be accompanied by other seizure symptoms.
  • Chiasmal Syndromes: Conditions affecting the optic chiasm, such as chiasmal gliomas or other rare tumors, can cause a variety of visual field defects. These are less common than other diagnoses listed here but are important to consider in the differential diagnosis due to their potential impact on vision and overall health.