Differential Diagnosis for the 75-year-old Man with Sudden Onset of Blurry Vision and Headache

• Single Most Likely Diagnosis

  • Papilledema due to Malignant Hypertension: The patient's symptoms of sudden blurry vision, headache, and complete loss of vision for several minutes, combined with the physical examination findings of swelling of the optic discs (papilledema) and peripheral blind spots, are highly suggestive of papilledema. The markedly elevated blood pressure (200/105) supports the diagnosis of malignant hypertension, which is a known cause of papilledema.

• Other Likely Diagnoses

  • Glaucoma: The patient's symptoms of sudden onset of blurry vision and headache, along with the finding of peripheral blind spots, could also be consistent with glaucoma, particularly acute angle-closure glaucoma. However, the presence of papilledema and the lack of other specific symptoms such as eye pain or nausea make this diagnosis less likely.
  • Retinal Vascular Occlusion: This condition could also present with sudden loss of vision, but the presence of papilledema and the patient's symptoms of transient complete loss of vision followed by return of central visual acuity make this diagnosis less likely.

• Do Not Miss Diagnoses

  • Giant Cell Arteritis: Although less likely given the patient's presentation, giant cell arteritis is a "do not miss" diagnosis due to its potential for causing permanent vision loss if not promptly treated. The patient's age and symptoms of headache could be consistent with this diagnosis, but the lack of other specific symptoms such as jaw claudication or temporal tenderness makes it less likely.
  • Meningitis: The patient's headache and vision changes could also be consistent with meningitis, particularly if there were other symptoms such as fever, stiff neck, or altered mental status. However, the patient's temperature is normal, and there are no other symptoms suggestive of meningitis.

• Rare Diagnoses

  • Optic Neuritis: This condition could present with sudden loss of vision, but the presence of papilledema and the patient's symptoms of transient complete loss of vision followed by return of central visual acuity make this diagnosis less likely.
  • Cerebral Venous Sinus Thrombosis: This rare condition could cause increased intracranial pressure leading to papilledema, but it would be an unusual cause of the patient's symptoms and would likely be associated with other neurological findings.