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Visual acuity loss can be due to eyeball diseases or to lesions of the optic nerves, visual pathway or cortical projection of vision. The differential diagnosis can be challenging and though patients go first to the ophthalmologist, there is not always the ophthalmologist who can diagnose and treat the patient. For a great number of causes/diseases, a neurologist should also see the patient, even if there is a transient or persistent monocular or binocular visual acuity loss a disturbance of the visual fi eld or of the perception of colours. Visual acuity loss can be more than this. It can be a symptom or a sign of a neurological or systemic disease and a rapid diagnosis and specific treatment are mandatory in order to treat the symptoms and improve the patient’s quality of life.

Visual acuity loss can be due to eye ball diseases or to lesions of the optic nerves, visual pathway or cortical projection of vision. The differential diagnosis can be challenging and though patients go first to the ophthalmologist, there is not always the ophthalmologist who can diagnose and treat the patient. For a great number of causes/diseases a neurologist should also see the patient even if there is a transient or persistent monocular or binocular visual acuity loss, or a disturbance of the visual field or of the perception of colours. Visual acuity loss can be more than this, it can be a symptom or a sign of a neurological or systemic disease and a rapid diagnosis and a specific treatment are mandatory in order to treat the symptoms and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

A quinquagenarian woman visited our hospital due to experiencing headache around the right upper eyelid for the previous 2 months. T 2 -weighted MRI of the head showed multiple high-signal-intensity lesions in the corpus callosum and bilateral corona radiata. She was thought to have an autoimmune disease and was treated with steroid pulse therapy, but the light reflex of the right eye diminished and the patient developed inferior horizontal hemianopsia. T 2 -weighted orbital MRI showed an enlarged right optic nerve, a high-intensity signal in the superior half of the optic nerve, and an enhancing effect. She also tested positive for anti-aquaporin 4 antibodies, so she was diagnosed with neuromyelitis optica spectrum disorder (NMOSD). This case shows that headache can be an initial symptom of NMOSD and that clinicians should consider NMOSD when attempting to diagnose patients presenting with headaches.