Bilateral optic atrophy

Article Outline

• 1. Clinical background
• 2. What is the most likely diagnosis?
• Copyright

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1. Clinical background 

A 34-year-old man presented initially with gastrointestinal symptoms and later developed neurological symptoms and signs (peripheral neuropathy and delirium) and alopecia. He was a strict vegetarian and took alcohol in moderation (50–100mL per week). A photograph of his fundus is shown (Fig. 1). He later developed diminution of vision with visual field constriction and defective colour vision (Fig. 2).

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• Fig. 1. 

  Photograph of the fundus showing distinct signs of atrophy together with a deep temporal excavation (arrows). (This figure is available in colour at www.sciencedirect.com.)

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• Fig. 2. 

  Visual evoked response showing increased latencies in both eyes (upper panel, right eye; lower panel, left eye).

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2. What is the most likely diagnosis? 

Answer on page 488.