Glioblastoma: initial presentation with a visual field defect

Prashant Shah MCOptom PGDipOphth DipClinOptom examines the case of a patient presenting with a homonymous visual field defect eventually diagnosed as a grade 4 brain tumour.

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Background history

A 65-year-old male had been attending our practice for regular sight tests for many years. His most recent routine eye examination was in June 2018, when he was asymptomatic, and all ocular exams including visual fields were within normal limits. 

Presenting symptoms and patient history

The patient returned in August 2018 with the following symptoms: in July he was watching football and suddenly couldn’t follow the ball across the screen. He decided to read a book instead; however, he found that he couldn’t see the left-hand side of the book and words at the beginning of sentences. This cleared up within 10 minutes. No other ocular or systemic symptoms were present. The patient thought it may have been a visual migraine so went to sleep. There were no symptoms the following morning. 

The same symptoms reoccurred two to three times over the following few weeks – each time lasting 10 minutes and clearing by themselves. Leading up to the August visit, he mentioned reading vision not being clear – specifically the beginning of words and sentences not being sharp, and that if he read for a while he developed a low-level non-specific headache. He thus attended a sight test, wondering if there was something wrong with his spectacles.

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