Retinitis Pigmentosa Misdiagnosed as Complicated Migraine-Reply

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In Reply. —We appreciate Dr MacKay's interest and suggestion that our patient had early RP. It is true that RP, especially sine pigmento, may be difficult to diagnose. As noted in our case report,1 we, too, were initially confounded by the abnormal ophthalmologic findings in the absence of an observable cause. However, the diagnosis of RP was considered and rejected. In response to Dr MacKay, we can add that there was never a question of a faulty patient history. Now an attorney, the patient was a truck driver at presentation and often drove at night. He was an excellent recorder of his visual changes; he complained that "swirling designs" and poor contrast developed during a period of about 1 month. There was no family history of nyctalopia or degenerative retinal diseases. We agree that the electrophysiologic changes were highly suggestive of peripheral retinal impairment from congenital nyctalopia, yet there

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