A 40-year-old white woman was referred to the Tufts Medical Center neuro-ophthalmology service for 3 weeks of blurred peripheral vision, pulse-synchronous tinnitus and headaches.
Her medical history included myopia and obesity. She denied taking any daily medications.
On thorough review of systems, she endorsed her heartbeat creating pulsations in her vision. She had two migraines in the past 6 months that resulted in emesis, but she denied transient visual obscurations, daily headaches, diplopia or pain with extraocular motility. Upon further questioning, she reported taking 800 mg ibuprofen