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ss nucleus - summer 1995,  Differential Diagnosis 12

Differential Diagnosis 12

Acts 13:6-12

Luke's history taking is again salient and clear; Elymas's vision suddenly became misty, blackness came over him and he groped around for some one to lead him.

The speed of onset suggests a vascular cause, and the total visual loss implies a bilateral event.

Cerebrovascular accident (CVA) of sufficient magnitude to cause complete blindness would also cause loss of consciousness, so this diagnosis can be excluded. Temporal arteritis (TA) may affect both eyes simultaneously but usually occurs in people over 70 - an unusual age in the first century. Embolic anterior ischaemic optic neuropathy (ANION) occurs in younger patients but tends to be unilateral.

Other possibilities include bilateral simultaneous central retinal artery occlusion (CRAO) or central retinal vein occlusion (CRVO), either primary or secondary to: a thrombogenic diathesis (PCRV, ALL, SLE, clotting modulation disorder), papilloedema or a massive hypertensive event. Small print includes; bilateral optic nerve drusen and bilateral optic nerve tumour infiltration.

While all of the above are possible explanations for sudden bilateral visual loss, usually one eye is affected first.

Luke, after consultation, thinks it looks supernatural!

Differential Diagnosis 13

There are few matters which have evoked more theological speculation than the identity of Paul's 'thorn in the flesh'. What is the evidence for it being a medical condition and, if so, which condition is most likely? (2 Cor 12:7-10).

Luke's opinion in next issue.

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