Differential Diagnosis for Sudden Onset of Noticeable Blind Spot

• Single most likely diagnosis:
  • Migraine with aura: This condition is characterized by transient visual symptoms, including blind spots (scotomas), which can be sudden in onset. The visual disturbances are often followed by a headache.
• Other Likely diagnoses:
  • Retinal detachment: Although typically associated with flashes of light and floaters, a retinal detachment can cause a sudden blind spot, especially if it involves the macula.
  • Optic neuritis: Inflammation of the optic nerve can lead to sudden vision loss, including blind spots, often accompanied by pain on eye movement.
  • Central serous retinopathy: This condition involves fluid accumulation under the retina, leading to sudden onset of blind spots or distorted vision, typically in one eye.
• Do Not Miss diagnoses:
  • Stroke or transient ischemic attack (TIA): A sudden blind spot, especially if accompanied by other neurological symptoms, could indicate a stroke or TIA. Prompt recognition is crucial for timely intervention.
  • Pituitary apoplexy: A rare but potentially life-threatening condition where a pituitary tumor suddenly hemorrhages or infarcts, leading to sudden visual field defects, including blind spots, often accompanied by severe headache and other neurological symptoms.
• Rare diagnoses:
  • Choroidal melanoma: Although rare, a large melanoma in the choroid layer of the eye can cause a blind spot by obstructing light as it enters the eye.
  • Occipital lobe seizures: Seizure activity in the occipital lobe can cause transient visual disturbances, including blind spots, which may be recurrent and could be a presenting symptom of underlying epilepsy.