Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, India

A 41 year old stout female introduced to our ophthalmology facility with rare migraine for a long time which didn't answer to any nearby treatment. Her far off vision was 6/6 and close to vision N12 in the two eyes. Foremost fragment assessment uncovered clear cornea, shallow front chamber with a profundity of Vanherick grade 1 by cut light assessment (Figure 1 and 2). Gonioscopy by Shaffer's

reviewing showed shut points in two quadrants with no fringe front synechiae. Students were ordinary with lively response. Undilated fundus assessment of the two eyes showed optic plate hyperemia also, edema. Laser fringe iridotomy was finished in the two eyes onseparate sittings, seven days separated. Developing of foremost chamber was clinically affirmed by post laser gonioscopy which showed open points. Enlarged fundus assessment uncovered clear media, hyperemic plate, edges obscured, cup wrecked and nonappearance of unconstrained venous throb. A conclusion of papilledema was made which was affirmed by estimating Retinal Nerve fiber Layer thickness around the plate by stratus Optical Rationality Tomography.

A dire neurological assessment and radio imaging of the cerebrum precluded space involving sore and cerebral venous apoplexy. Cerebrospinal liquid assessment by lumbar cut was typical with the exception of opening tension of 290 mm of H2 O. Consequently conclusion of idiopathic intracranial hypertension was made. Patient was begun on oral acetazolamide 250 mg four times each day and the patient gotten to the next level decisively. Subacute point conclusion glaucoma is overwhelmingly seen in females. The condition has additionally been called discontinuous, prodromal or then again subclinical [1]. The principal introducing side effect is migraine and shaded coronas.

Gonioscopy shows occludable point which opens in 66% of patients after YAG iridotomy. Fundus assessment uncovers a typical plate or could show highlights of glaucomatous measuring. However, the presence of plate edema in subacute point conclusion has not been accounted for till now. Hyperemic and enlarged optic circle might happen during intense assault of point conclusion glaucoma which is probably from debilitated axoplasmic stream or hypotony following the assault [2].This patient has provided us with a shock of plate edema without any elements of intense point conclusion assault, representing a symptomatic test between subacute point conclusion with plate edema and papilloedema. Fundus If gonioscopy shows an occludable angle, examination for disc cupping assessment is necessary, whether the disc is undilated or dilated following preventive laser treatment. Combining the efforts of neurologists and ophthalmologists can occasionally save lives in addition to helping patients with headache symptoms.

1. R Ramakrishnan, Saurabh Mittal, SonalAmbatkar, Mohideen A Kader. Retinal nerve fibre layer thickness measurements in normal Indian population by optical coherence tomography. Indian J Ophthalmol. 2006;54(1);11-5.

2. Becker- Shaffer’s Diagnosis And Therapy Of The Glaucomas - 8 Th Edition. Mosby Elsevier: 2010;189- 98

Tharini Senthamizh. Ocular or neurological causes of headaches? - A Diagnostic Conundrum. Insights of Clinical and Medical Images 2022.