| Identifier |
walsh_2014_s3_c4-1 |
| Title |
Almost Catastrophic |
| Creator |
Danielle S. Rudich, Samuel Yun, Anne Liebling, Jonathan E. SIlbert, Robert L. Lesser, MD, The Eye Care Group, Clinical Professor of Ophthalmology and Visual Science and Neurology at Yale, Clinical Professor of Neurology and Surgery (Neurosurgery) at the University of Connecticut School of Medicine |
| Subject |
Papilledema; Visual Field Loss; Cerebral Venous Sinuses |
| History |
A 36 year-old Caucasian male presented to his ophthalmologist with one month of headache, blurry vision, and intermittent diplopia. The patient denied transient visual obscurations, tinnitus, prior medical problems or use of steroids/Vitamin A/antibiotics. He was 235 pounds and 5'9". Because examination showed bilateral optic disc edema he was referred to an ER where MRI/MRV/MRA showed a partially empty sella turcica and no cerebral venous sinus thrombosis (CVST). LP opening pressure was 40mmHg with normal CSF profile. Idiopathic intracranial hypertension (IIH) was diagnosed. Acetazolamide 500mg bid was started. He was discharged with recommended follow up with a neurologist in several weeks. He returned to his ophthalmologist who then referred him to neuro-ophthalmology. Blood pressure was 123/79. Visual acuity was OD 20/40 +2 , OS 20/30. Diplopia had resolved. There was no RAPD and he was orthophoric. Color vision (Ishihara) was 13/15 OU. Humphrey visual fields showed enlargement of the blind spot OU with inferonasal field loss OS>OD. Grade IV-V disc edema with hemorrhages and exudates extending into the macula was present OU. Given the dramatic papilledema and field loss, acetazolamide was increased to 500mg qid and optic nerve sheath decompression was scheduled. Prednisone was prescribed until surgery could be arranged. Pre-operative testing revealed microcytic anemia and thrombocytopenia (hemoglobin 7.1, hematocrit 23.4, platelets 45,000, MCV 48, PTT 31.4). Surgery was postponed and the patient was referred to a hematologist who felt that the patient had idiopathic thrombocytopenia and iron deficiency anemia. The patient then developed nephrolithiasis treated with a renal stent. Diamox was discontinued and prednisone was decreased. Several days later, he was found to have a rapidly rising BUN (53mg/dL) and creatinine (2.4 mg/dL). Urinalysis showed 2+ protein with many RBC and WBC. Additional testing was performed. |
| Disease/Diagnosis |
Pseudo idiopathic intracranial hypertension with almost catastrophic antiphospholipid antibody syndrome with renal, ocular and hematological involvement. |
| Presenting Symptom |
A 36 year-old Caucasian male presented to his ophthalmologist with one month of headache, blurry vision, and intermittent diplopia. |
| Neuroimaging |
Magnetic Resonance Imaging |
| Date |
2014-03 |
| References |
1. Joseph R, Radhakrishnan J, Appel G. Antiphospholipid antibody syndrome and renal disease. Hypertension. 2001; 10:175-181. 2. Orefice G, De Joanna G, Coppola M et al. Benign intracranial hypertension: a non-thrombotic complication of the primary antiphospholipid syndrome? Lupus. 1994; 4:324-326. 3. Sussman J, Leach M, Greaves M, Malia R, Davies-Jones. Potentially prothrombotic abnormalities of coagulation in benign intracranial hypetension. Journal of Neurology. 1997;62:229-233. 4. Pendse S, Bilyk JR, Olivia C, Biousse V. Now you see it. Survey of ophthalmology. 2008;53:177-82. 5. Jadhav A, Aghaebrahim N, Jankowitz B et al. Cerebral Microbleeds in Lupus Anticoagulant- Hypoprothrombinemia Syndrome. JAMA Neurology. 2013: E1-E2. |
| Language |
eng |
| Format |
application/pdf |
| Type |
Image |
| Source |
46th Annual Frank Walsh Society Meeting |
| Relation is Part of |
Case presented at the NANOS 2014 Walsh Session, March 2 |
| Collection |
Neuro-Ophthalmology Virtual Education Library - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6275 |
| Rights Management |
Copyright 2014. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6jq3xkn |
| Setname |
ehsl_novel_fbw |
| ID |
179201 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6jq3xkn |
