History
A  30  year old man , previously healthy,  presented to our ER  with severe frontal headache and decreased visual acuity of 5 days duration.
The pain is deeply located, non-throbbing, described as excruciating pressure  waking the patient during sleep,  with  mild  vertigo, and sometimes tinnitus.
There is no associated photophobia, photopsias, scintillations,  sensory "auras" or  altered consciousness. There is neither a  recognized precipitating or exacerbating factor, nor a predilection for a specific time of the day.
No other neurologic or systemic complaints  were reported.

General Exam

General appearance:  moderately obese middle- aged in mild distress.

Vital Signs:  BP= 140/80 in all extremities,  HR= 100,    RR= 18 ,  Temp: 37 º C
Heart / lung exam is normal.
Neurologic exam: normal; Intact cranial nerves, negative cerebellar signs...

Ophthalmologic exam

Normal extaocular muscle action in all directions. No pain on motion.
No APD
No Anisocoria
Color vision using Ishihara plates is significantly deficient.

Vision : 20/100  OU . ( Pinholing deteriorated vision to counting fingers 3m  in both eyes.) 
Slit lamp exam: 
Normal anterior segment
Fundus: 

OD showed same picture as OS
Optic nerve head (in both eyes) is significantly elevated, with blurring of  margins, vessels looping out and into the retinal plane when  coursing over the elevated  ONH edge.
Macula: normal OU

No other ocular abnormalities noticed.
No medications were used by the patient.

Work-up

MRI of the brain : normal

B-scan.: elevated punched-out ONH into the vitreous , no  other vitreoretinal or choroidal   pathologies  noted.

Visual field  revealed significant defects in both eyes.