| Identifier |
walsh_2015_s2_c2-1 |
| Title |
Three Weeks in Florida |
| Creator |
Andrew R. Carey; J. Antonio Bermudez-Magner; Sander R. Dubovy; Norman J. Schatz; Linda L. Sternau; Byron L. Lam |
| Affiliation |
(ARC) (JAB) (SRB) (NJS) (BLL) Bascom Palmer Eye Institute / University of Miami / Miller School of Medicine / Department of Ophthalmology Miami, FL; (LLS) Memorial Regional Hospital / Department of Neurosurgery Hollywood, FL |
| Subject |
Papilledema, Leptomeningeal Melanomatosis, Vision Loss, Headache, Magnetic Resonance Imaging |
| History |
A 36 year-old man presented with severe headaches, bilateral leg numbness, and bilateral decreased vision. He was born in Ecuador where he received BCG vaccination and immigrated to US at age 19. In 2005 he enrolled in nursing school and volunteered in homeless shelters. PPD was positive with a negative chest x-ray. In August 2011 he developed pleuritic chest pain; chest x-ray showed a 2 cm cavitary lesion in the right upper lobe. He was diagnosed with active TB and completed treatment in August 2013. In December 2013 he developed headaches associated with neck stiffness and intermittent blurry vision which progressed over 6 months. In May 2014, while on vacation in Ecuador, he had a prolonged seizure requiring intubation. Upon recovery he returned to Florida and presented to the emergency department with visual loss and drowsiness, but arousable to verbal stimuli. Vision was light perception OU with sluggish pupils. Extraocular movements were full but demonstrated exotropia. Fundus examination showed papilledema. Strength was reduced in all four limbs with apraxia in the upper right. Sensation was decreased from groin to foot, left worse than right. Serum white count was elevated to 25,300. Brain MRI demonstrated hydrocephalus and diffuse leptomeningeal enhancement including bilateral intracranial optic nerves and chiasm. CSF analysis showed 110 leukocytes with 66% monocytes. Lumbar spine MRI was negative. The patient was diagnosed with recurrent TB with meningitis and was restarted on TB medications. CSF smears, cultures, and PCR were negative for infection including TB. Lumbar drain was placed and ICP was 40 cm water. Repeat brain MRI showed progressive leptomeningeal enhancement and hydrocephalus. Repeat CSF analysis demonstrated cellular atypia with equivocal immuno-histochemical staining. Flow cytometry revealed a mixture of immune cells but no B lymphocytes. A diagnostic procedure was performed. |
| Disease/Diagnosis |
Primary Leptomeningeal Melanomatosis |
| Date |
2015-02 |
| References |
1. Arias M 1 , Alberte-Woodward M, Arias S et al. Primary malignant meningeal melanomatosis: a clinical, radiological and pathologic case study. Acta Neurol Belg. 2011 Sep;111(3):228-31. 2. Bot I, Blank CU, Brandsma D. Clinical and radiological response of leptomeningeal melanoma after whole brain radiotherapy and ipilimumab. J Neurol (2012) 259:1976-1978 3. Burrows AM 1 , Smith TW, Hall WR, Pilitsis JG. Neurological picture. Ascending paralysis from malignant leptomeningeal melanomatosis. J Neurol Neurosurg Psychiatry. 2010 Apr;81(4):449-50 4. Harstad L 1 , Hess KR, Groves MD. Prognostic factors and outcomes in patients with leptomeningeal melanomatosis. Neuro Oncol. 2008 Dec;10(6):1010-8. 5. Hsieh YY 1 , Yang ST, Li WH, Hu CJ, Wang LS. Primary Leptomeningeal Melanoma Mimicking Meningitis: A Case Report and Literature Review. J Clin Oncol. 2014 Mar 17 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
47th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2015 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2015. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6bp30fg |
| Setname |
ehsl_novel_fbw |
| ID |
179280 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6bp30fg |
