SL 25 yo Asian Female

CC:
Left eye has an "amaurosis fugax" sensation inferior nasally.
Began sometime in April.
Initially occurred suddenly and lasted more than 30 minutes, now about 30 seconds to 5 minutes.
Occurs spontaneously, more often when getting up from laying or sitting position.
(-) associated symptoms: (-) HA, pain, diplopia
**Pt notes at the time it first occurred,
    - Optos was taken immediately with no abnormalities to extent seen .
    - an intern performed fundus and found no spasming of BV or abnormalities to extent seen.
    - pt talked to faculty and was told it was likely ocular migraine, so no dilation was performed that day.

PmedHx:
+ N/A
+ mononucleosis (resolved in spring 2013)
+ low blood pressure: 94-110 / 70

FmedHx:
+ hypercholesteremia: father, grandfather on fathers side
+ stroke/aneurysm in uncle (father side) when he was 19 yo
+ migraines: father, mother, sister
(-) glaucoma, diabetes, HTN

VA: 20/20 OD, OS at distance and near
IOP: 20 OD, OS note: this is the norm
Pupils: PERRL (-) APD equal in size
EOM: Full and unrestricted (-) pain, diplopia noted

Visual Field - SITA standard C-30-2 
OD normal
Mild OS attitudinal defect.  Pt did not notice any part of vision missing, although left eye seems a bit "darker"

Amsler Grid
(-) defects OD, OS

Fundus and BIO
OD normal (-) holes, tears, retinal detachments
       C/D: 0.20 round, pink healthy rim, distinct margins
       Macula: (+) foveal reflex, flat
OS (-) holes, tears, retinal detachments
      + Swollen optic nerve (-) distinct margins, pallor C/D: ~0.20 cannot tell due to swelling
      + Cotton wool spots along arcades and nasal; none near macula
      + Flame hemorrhages along arcades and nasal; none near macula
      Macula: (+) foveal reflex, flat

note: doctor does not have OPTOS........

Optic Nerve Evaluation
Red cap test: (-) differences noted
D-15 saturated: normal
D-15 desaturated: 
- first attempt, desaturated red hues were mixed up
- second attempt normal

Differentials
1. N-AION (A-AION, although unlikely due to age and no note of pain, jaw claudication)
2. CRVO

Due to:
1. Clotting disorder
2. Vasculitis
3. Mass compression: clot, tumor, inflamed vessel...etc.
4. Autoimmune disorder


Ruled out: 
Glaucoma (side note: pt's pachymetry 600 um OD, OS)
Brain mass (-) bilateral VF loss, abnormalities in gait, speech, HA...etc.

Referrals/Orders made:
1. Neuro-opthalmologist
2. Retinal-ophthalmologist
3. MRI of orbit: with and without contrast
4. Blood tests: platelet count, CRP, ESR, various anti-body panels
5. Fluorescein Angiography
6. OCT to evaluate retinal thickness

Advised
- 325 mg aspirin PO qD
- patient not to go on airplanes in case eye strokes out due to change in pressure!!!