SHM Converge Scientific Abstract ePoster Gallery-It's Blurry

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This case report describes a 34-year-old woman who developed acquired optic neuropathy after fasting for seven weeks, leading to significant weight loss, dehydration, weakness, and blurry vision. On examination, she had bilateral vertical and horizontal nystagmus, reduced visual acuity (20/70), and signs of malnutrition. Laboratory findings showed anion gap metabolic acidosis with elevated lactate, hypophosphatemia, mild transaminitis, and low thiamine (B1) and folate levels, while B12 was elevated. Brain MRI was normal, and neurologic and ophthalmologic evaluations supported a diagnosis of nutritional optic neuropathy rather than a structural brain lesion.<br /><br />Acquired optic neuropathy is damage to the anterior visual pathway, often affecting the papillomacular bundle and causing central or cecocentral scotomas, reduced color vision, and blurred vision. It is more common in settings of malnutrition or vitamin deficiency, including famine regions and in developed countries among patients with alcohol/tobacco use or after bariatric surgery. In this patient, the cause was prolonged fasting with vitamin deficiency, despite no history of alcohol, tobacco, or bariatric surgery.<br /><br />Treatment focused on nutritional rehabilitation and vitamin replacement, including folate, vitamin B12, and high-dose IV thiamine, followed by oral supplementation. She was monitored for refeeding syndrome and electrolytes were corrected as needed. Her vision and nystagmus improved during hospitalization, with visual acuity improving to 20/40 bilaterally by discharge.<br /><br />The report emphasizes that although uncommon in the United States, acquired optic neuropathy should be considered in undernourished patients. Early recognition and prompt vitamin repletion are key, as recovery is often good if treatment begins before severe irreversible vision loss occurs.

Asset Subtitle

Hussein Mhanna

Meta Tag

Author List Hussein Mhanna, Roveena Goveas

Category Clinical Vignettes

Concept Acquired Optic Neuropathy

Concept Central Scotoma

Concept Papillomacular Bundle

Concept Malnutrition

Concept Thiamine Deficiency

Distinguished Non-Finalist

Presenter Organization Hackensack Meridian Health Mountainside Medical Center

Presenting Author Hussein Mhanna

Track Adult

Keywords

acquired optic neuropathy

nutritional optic neuropathy

thiamine deficiency

fasting

malnutrition

blurred vision

nystagmus

vitamin deficiency

refeeding syndrome

visual acuity

Acquired Optic Neuropathy

Central Scotoma

Papillomacular Bundle

Malnutrition

Thiamine Deficiency