A 78-year-old woman presents with a 1-day history of blurred vision in the right eye. She experienced the change suddenly and without any warning. She has also noticed a loss of appetite, a 5-kg weight loss, and headaches and pain in the neck and shoulder regions over the past 2 months. Upon questioning, she admits to pain in the jaw while chewing and scalp sensitivity (ie, tenderness to touch).
On examination, visual acuity is 20/25 in the left eye and she sees only hand motion in the right eye; there is a right relative afferent papillary defect. Results of fundoscopy reveal optic disk edema that has a chalky white colour. The left optic nerve appears normal. Both erythrocyte sedimentation rate and C-reactive protein levels are markedly elevated.
The most likely diagnosis is
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Nonarteritic anterior ischemic optic neuropathy
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Papilledema
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Optic neuritis
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Temporal arteritis
Answer on page 1296
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