Never Too Young or Too Old

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Identifier walsh_2021_s1_c2-video
Title Never Too Young or Too Old
Creator Bart Chwalisz, Laurel Tainsh, Mary Maher, Samantha Champion, Shuhei Nishiyima, Michael Levy
Subject Neuromyelitis Optica Spectrum Disorder (NMOSD); Myasthenia Gravis; Optic Chiasm; Optic Neuritis
History An 81-year-old woman with history of ocular myasthenia gravis presented with sequential bilateral vision loss. Six days before presentation, she discovered that vision of her left eye was reduced to light perception. She did not have any eye pain, pain with eye movement, headache, scalp tenderness, jaw claudication, muscle soreness, rash, or joint aches. An ophthalmologist, documented no light perception vision with an afferent pupillary defect on the left, and a normal visual acuity on the right but visual field testing demonstrated a dense hemifield defect in the right eye. Dilated funduscopic exam was normal. A non-contrast brain MRI was reported as normal. CTA Head and Neck showed moderate to severe stenosis of one of the vertebral arteries. Erythrocyte sedimentation rate was 55 but due to absence of symptoms suggestive of temporal arteritis, she was not started on steroids but instead diagnosed with a stroke and treated with dual antiplatelet therapy. Four days later, the patient woke up with vision in the right eye severely diminished to the point of seeing only outlines and movement. The next day, vision worsened to bilateral no light perception. On examination, pupils were slightly reactive to light but there was a left afferent pupillary defect. The right and especially the left optic disc were felt to be slightly pale. IV steroids were started for suspected giant cell arteritis. An MRI brain and orbits with contrast revealed enlargement and enhancement of the bilateral proximal prechiasmatic optic nerves, optic chiasm, and proximal optic tracts with extension into the hypothalamus. MRI cervical and thoracic spine was normal. CSF was notable for no pleocytosis but a mildly elevated protein of 59 mg/dL, with negative CSF cytology and oligoclonal bands. Additional studies were obtained. Eight months later the patient died of an unrelated cause, and an autopsy was performed.
Relation is Part of NANOS Annual Meeting 2021: Walsh Session I
Contributor Primary Bart K. Chwalisz, MD
Contributor Secondary Laurel Tainsh, Mary Maher, Samantha Champion, Shuhei Nishiyima, Michael Levy
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2021-02
Type Image/MovingImage
Format video/mp4
Source 53rd Annual Frank Walsh Society Meeting
Rights Management Copyright 2021. For further information regarding the rights to this collection, please visit:
Holding Institution North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s6b05479
Setname ehsl_novel_fbw
Date Created 2021-05-21
Date Modified 2021-05-21
ID 1697337
Reference URL