A 16-Year-Old Boy Is Brought to the Clinic for Evaluation

A 16-year-old boy is brought to the clinic for evaluation of headaches.  For the last month, he has had daily, throbbing pain in the frontal region that is worse in the morning and occasionally associated with nausea and vomiting.  Acetaminophen provides some relief.  The patient also had several brief episodes of blurriness in his left eye during football practice last week.  In addition to acetaminophen, he takes oral isotretinoin for severe acne.  Temperature is 36.7 C (98.1 F) , blood pressure is 130/80 mm Hg, pulse is 70/min, and respirations are 15/min.  The patient is sitting up and cooperative with the examination.  The pupils are equal and reactive to light.  Eye examination shows bilateral optic disc edema and decreased visual acuity.  The visual fields are full.  There is no neck stiffness.  Motor examination reveals 5/5 strength, 2+ deep tendon reflexes, and a normal plantar response.  Sensory examination is unremarkable.  Which of the following is the most likely cause of this patient's symptoms?

A) Cluster headaches
B) Medication side effect
C) Optic chiasm glioma
D) Optic neuritis
E) Viral encephalitis

Correct Answer:

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