Non-arteritic anterior ischemic optic neuropathy (NAION)

Sudden painless monocular vision loss from occlusion of the posterior ciliary artery by giant cell arteritis infarcts the optic nerve head and threatens the fellow eye within days. Treatment with high-dose glucocorticoids must begin on clinical suspicion, before biopsy confirmation, because established blindness is usually permanent.

Giant cell arteritis is a granulomatous large- and medium-vessel vasculitis of patients over 50 that threatens irreversible blindness through ischemic optic neuropathy. Diagnosis is clinical and must not delay treatment: start high-dose glucocorticoids immediately on suspicion, intravenous methylprednisolone pulse for visual loss, then confirm with temporal artery biopsy within 1 to 2 weeks and add tocilizumab as glucocorticoid-sparing therapy.

Polymyalgia rheumatica (PMR) is an inflammatory disorder of older adults causing aching and prolonged morning stiffness of the shoulder and hip girdles with elevated inflammatory markers, but without true weakness and with a normal creatine kinase. It is a clinical diagnosis, and treatment begins with prednisone 12.5 to 25 mg/day, which produces a dramatic response within days.

Optic neuritis is inflammatory demyelination of the optic nerve, usually a presenting event of multiple sclerosis, causing subacute painful monocular vision loss with a relative afferent pupillary defect. Confirm with MRI orbits/brain and treat with IV methylprednisolone followed by an oral prednisone taper, never oral prednisone alone.

Central retinal artery occlusion is sudden, painless, profound monocular vision loss from embolic or thrombotic occlusion of the central retinal artery, an ocular stroke equivalent in which irreversible retinal infarction begins around 90 minutes after complete occlusion. Diagnosis is clinical on dilated fundoscopy, and management pairs time-critical reperfusion attempts with an emergency embolic and giant-cell-arteritis workup to protect the fellow eye and prevent a subsequent stroke.

Central retinal vein occlusion causes sudden, painless, variable monocular vision loss from thrombosis of the central retinal vein, is treated with intravitreal anti-VEGF for macular edema, and carries a real risk of neovascular glaucoma in the ischemic subtype.

Amaurosis fugax is transient, painless monocular vision loss from retinal ischemia, most often microembolic from an ipsilateral carotid or a cardiac source, and it is treated as a TIA-equivalent with urgent carotid/cardiac workup and immediate aspirin 81 mg daily plus a high-intensity statin.

Papilledema is bilateral optic disc swelling from raised intracranial pressure, most classically idiopathic intracranial hypertension; imaging to exclude a mass lesion or venous sinus thrombosis must precede lumbar puncture, and acetazolamide is the first-line drug once idiopathic intracranial hypertension is confirmed.

Idiopathic intracranial hypertension (formerly pseudotumor cerebri) is raised intracranial pressure of unclear cause, without a mass lesion or hydrocephalus, occurring mainly in obese women of childbearing age and presenting with headache, papilledema, and visual symptoms. Diagnosis requires an elevated lumbar puncture opening pressure with normal CSF and normal or empty-sella imaging; treatment centers on weight loss and acetazolamide to protect vision, with surgery reserved for medically refractory disease.

Multiple sclerosis is an autoimmune, demyelinating CNS disorder causing optic neuritis, myelitis, and brainstem/cerebellar syndromes separated in space and time. Diagnosis uses the McDonald MRI-based criteria; acute relapses are treated with high-dose glucocorticoids, and disease-modifying therapy (interferon beta, glatiramer, or a higher-efficacy agent such as ocrelizumab or natalizumab) is started early to prevent relapse and disability accumulation.

Essential (primary) hypertension is chronically elevated blood pressure without an identifiable secondary cause, the overwhelming majority of hypertension. It is a leading modifiable driver of stroke, heart failure, and kidney disease, and management combines lifestyle change with staged pharmacotherapy to a target usually below 130/80 mmHg.

Dyslipidemia is an abnormal lipid profile, chiefly elevated LDL cholesterol, that drives atherosclerotic cardiovascular disease. Management is risk-based LDL lowering with statins as the foundation, adding ezetimibe and PCSK9 inhibitors to reach targets, alongside lifestyle change and evaluation for severe genetic forms and hypertriglyceridemia.

Type 2 diabetes is hyperglycemia from insulin resistance with progressive relative insulin deficiency, diagnosed by a hemoglobin A1c of 6.5% or higher, a fasting glucose of 126 mg/dL or higher, or a 2-hour oral glucose tolerance test value of 200 mg/dL or higher. First-line treatment is lifestyle modification plus metformin, with an SGLT2 inhibitor or GLP-1 receptor agonist added early for patients with atherosclerotic disease, kidney disease, or heart failure.

Obstructive sleep apnea is repetitive upper airway collapse during sleep, diagnosed by an apnea-hypopnea index of 5 or more per hour with symptoms, or 15 or more per hour regardless of symptoms, and treated first with weight loss plus positive airway pressure.

Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance for at least 6 months, most often from vascular, neurologic, medication, endocrine, or psychological causes, and is a significant marker of coronary risk. Diagnosis is clinical from history and exam with targeted labs, and first-line treatment is an oral phosphodiesterase-5 inhibitor unless the patient takes nitrates.