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A man aged 39 years had a 5 month history of headaches, intermittent episodes of blurred vision and worsening vision loss. He also reported mild lower back pain, constipation and erectile dysfunction. On examination, he had papilloedema (Frisen grade 3), decreased visual acuity (limited to hand movements in the right eye and 6/9 in the left) and a peripheral visual field defect. There was also superficial hypoaesthesia in his left leg and an extensor right plantar response.