{
  "abstract": "A 66-year-old man presented to ophthalmology with 2 days of painless vision loss and 4 weeks of unsteady walking. He had no headache, weight loss or constitutional symptoms. He had hypertension and ischaemic heart disease and took aspirin, bisoprolol and atorvastatin. He smoked heavily (50 pack-years). He had a refractive error in vision, for which he wore glasses. On examination, his visual acuity was impaired: right eye 6/60 (pinhole 6/24), left eye 6/12 (pinhole 6/9), with preserved colour vision (Ishihara plates 15/15 bilaterally). Pupillary reflexes and eye movements were normal and visual fields were full to bedside confrontation. There was no relative afferent pupillary defect. Funduscopy identified bilateral optic disc swelling, also evident on Optos widefield imaging of the fundi ( figure 1A,B). Slit-lamp examination showed cells in the vitreous. The bilateral optic disc swelling and vitreous cells were confirmed by optical coherence tomography (OCT), which also identified subretinal fluid extending into the papillomacular junction but not the fovea (figure 1C,D). His retinal nerve fibre layer (RNFL) was thickened bilaterally, more pronounced in the right eye than the left (figure 1G,H). Ganglion cell layer analysis was normal in both eyes (figure 1K,L). The findings were described as ‘gross papilloedema’, prompting medical admission for suspected raised intracranial pressure (ICP) from, for example, an intracranial mass, cerebral venous sinus thrombosis or idiopathic intracranial hypertension.",
  "authors": [
    {
      "affiliations": [
        "Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK",
        "Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, UK",
        "Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Gashirai K Mbizvo"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Anna Visca"
    },
    {
      "affiliations": [
        "Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Saif Huda"
    },
    {
      "affiliations": [
        "Department of Brain Repair & Rehabilitation, Institute of Neurology, University College London, London, UK"
      ],
      "name": "Andrew J Larner"
    }
  ],
  "title": "Thinking beyond papilloedema: importance of cells in the vitreous",
  "uid": "02129291-e8ab-5109-b9f1-f070e021216d"
}