| Identifier |
walsh_2015_s3_c1 |
| Title |
Now you see it. Now you don't. |
| Creator |
Prem S. Subramanian |
| Affiliation |
Wilmer Eye Institute Baltimore, MD |
| Subject |
Vision Loss; Optic Neuropathy; Facial Pain; Transverse Myelitis; Neuromyelitis Optica |
| Description |
MRI brain/orbits was ordered and showed asymmetric enlargement and enhancement of the left optic nerve from its cisternal segment to the orbital apex, as well as scattered white matter lesions of the pons. Optic neuritis rather than ischemic optic neuropathy was suspected; a paraneoplastic antibody screen as well as inflammatory markers including NMO-IgG were ordered. NMO-IgG seropositivity was found (Mayo cell-based assay), and studies for syphilis, Lyme, TB, and sarcoidosis were negative or normal. About 5 weeks after presentation, the patient developed right sided facial, body, and extremity numbness, facial pain, and difficulty walking. She was admitted to the hospital, and MRI c-spine showed longitudinally extensive demyelinating lesion, giving her a definitive diagnosis of NMO. Plasmapheresis was performed and systemic symptoms improved. Rituximab infusions were initiated for long-term disease control. Vision has remained stable, and repeat imaging 2 months later showed reduced left optic nerve enhancement but persistent pontine lesions. |
| History |
A 70 yo RH African American female presented to our institution with sequential, severe vision loss inthe preceding 4 months. Her past medical history included well-controlled hypertension andhyperlipidemia, CAD s/p coronary stent placement x 2 after MI, and stroke. She had no prior history ofvisual loss or eye surgeries. She was well until January 2014 when she was hospitalized for severecholangitis complicated by septic shock requiring vasopressor support in the ICU. She does not recallexactly when she lost vision in her left eye but suspects it was during the hospitalization. In mid-April2014 she was noted with Va 20/70 OD and NLP OS, had a left RAPD, and possible left optic discpallor. Decreased vision OD was consistent with cataract, and uncomplicated surgery was performed on5/2/14. She noted poor vision postop, and on 5/5/14 was HM OD and NLP OS with possible pallor ofthe right optic disc. ESR reported 3 days later was 102, and she was prescribed prednisone 60 mg po qd.Bilateral temporal artery biopsies were performed and were read as negative. Prednisone was taperedover the next month to 10 mg daily with some vision improvement OD. She then presented to ourinstitution on 7/10/14 with Va 20/400 OD and NLP OS. The left pupil was amaurotic. Fundus examshowed mild pallor of both optic discs. OCT of the RNFL and macular GCC demonstrated diffuse loss.She remained on 10 mg prednisone daily at that time and felt her vision was slowly improving. Adiagnostic procedure was performed. |
| Disease/Diagnosis |
Neuromyelitis optica |
| Date |
2015-02 |
| References |
None |
| Language |
eng |
| Format |
application/pdf |
| Format Creation |
Microsoft PowerPoint |
| Type |
Text |
| Source |
47th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting 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 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6m0731f |
| Setname |
ehsl_novel_fbw |
| ID |
179309 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6m0731f |
