A Small Leak Will Sink a Great Ship

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Identifier walsh_2021_s2_c2-video
Title A Small Leak Will Sink a Great Ship
Creator Konstantinos Douglas, Vivian Paraskevi Douglas, Cameron Sadegh, David Chow, Sigurros Davidsdottir, Ganesh Shankar, Bradley Buchbinder, Bart Chwalisz
Subject Alzheimer
History A 68 -year-old right -handed man presented for evaluation of progressive and fluctuating polyopia, gait instability and cognitive changes of about 14 months. Prior medical history was notable for Crohn's disease in remission, atrial fibrillation, a single episode of aseptic meningitis 12 years prior, retinal detachment status post retinopexy and early macular degeneration. The neuro-ophthalmic examination showed visual acuities of 20/40 OD and 20/20 OS, and mild bilateral difficulty with Ishihara color plates. Goldmann visual field test showed bilateral mild constriction. Assessment of higher cortical visual function with the CORVIST battery showed significant difficulties with both basic occipital function and higher cortical visual functions. He also appeared to have more difficulty with right-sided than left-sided parietal function. 18F-FDG PET scan of the brain showed prominent lateral occipital, lateral parietal, and posterior temporal lobe hypometabolism bilaterally. Neuropsychological testing confirmed multidomain impairment most severely affecting visual processing. On initial MRI of the brain, diffuse smooth pachymeningeal contrast enhancement in the supra-and infra-tentorial compartments as well as mild tonsillar and central brain descent was demonstrated suggestive of intracranial hypotension. MRI of the cervical, thoracic, and lumbosacral spine disclosed no evidence of an extradural fluid collection to specifically suggest a CSF leak. A CT myelogram failed to reveal a CSF leak. Intracranial hypotension did not resolve with two empiric blood patches. Additional diagnostic studies were obtained.
Relation is Part of NANOS Annual Meeting 2021: Walsh Session II
Contributor Primary Konstantinos Douglas, MD, DVM, MBA
Contributor Secondary Vivian Paraskevi Douglas, Cameron Sadegh, David Chow, Sigurros Davidsdottir, Ganesh Shankar, Bradley Buchbinder, Bart Chwalisz
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: https://NOVEL.utah.edu/about/copyright
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 http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6p61mtc
Setname ehsl_novel_fbw
Date Created 2021-05-21
Date Modified 2021-05-21
ID 1697342
Reference URL https://collections.lib.utah.edu/ark:/87278/s6p61mtc