Papilledema secondary to intracranial venous sinus stenosis, exacerbated by hypertensive emergency
D. All of the above
Optic nerve edema can result from several causes. In this patient, hypertensive papillitis, neuroretinitis, and papilledema from intracranial hypertension were all in the differential diagnosis. Therefore, all of the above testing (choice D) was warranted to ensure a timely and accurate diagnosis. In the setting of hypertensive emergency, the patient was admitted for control of blood pressure and treatment of systemic sequelae. Hypertensive papillitis can present with macular exudation and optic nerve head edema.1 However, concluding that systemic hypertension was the sole underlying cause of the optic nerve head swelling would be inadequate management (choice A). No further update is available for suspected renal artery stenosis as an underlying cause for his malignant hypertension, as the patient is lost to follow-up.