Differential Diagnosis for the Patient's Condition

The patient presents with sudden onset of blurry vision, headache, and transient complete loss of vision, along with findings of optic disc swelling and peripheral blind spots. Considering these symptoms and findings, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Papilledema: This condition is characterized by swelling of the optic discs due to increased intracranial pressure, which can cause transient vision loss, headaches, and is consistent with the patient's presentation of optic disc swelling and peripheral blind spots. The patient's significantly elevated blood pressure could contribute to or exacerbate this condition.

• Other Likely Diagnoses

  • Glaucoma: Specifically, acute angle-closure glaucoma can present with sudden onset of blurry vision, headache, and elevated intraocular pressure, which could lead to optic disc swelling and vision loss. However, the presence of peripheral blind spots and intact central visual acuity, along with the lack of specific symptoms like severe eye pain and nausea, makes this less likely but still a consideration.
  • Retinal Vascular Occlusion: This condition can cause sudden vision loss but typically presents with more profound and persistent visual field defects than what is described, and it might not directly explain the optic disc swelling observed.

• Do Not Miss Diagnoses

  • Retinal Detachment: Although less likely given the description, retinal detachment is a medical emergency that can cause sudden vision loss and requires immediate intervention. The presence of peripheral blind spots could be a symptom, but typically, patients also report flashes of light and floaters.
  • Cerebral Vasculature Event (e.g., Stroke): Given the patient's history of hypertension and hyperlipidemia, along with the sudden onset of symptoms, it's crucial to consider the possibility of a cerebral event affecting vision, such as a stroke. The high blood pressure reading further supports the need to rule out such conditions.

• Rare Diagnoses

  • Migraine with Aura: Some migraines can present with visual disturbances, including blind spots, but the presence of optic disc swelling and the severity of the vision loss make this a less likely explanation.
  • Optic Neuritis: This condition can cause vision loss and pain with eye movement but typically does not present with the sudden, transient complete loss of vision described, nor does it directly explain the significantly elevated blood pressure or the specific pattern of visual field defects.