| 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 |
| Affiliation |
(KD) (VPD) Massachusetts Eye and Ear, Boston, Massachusetts; (CS) (DC) (SD) (GS) (BB) (BC) Massachusetts General Hospital, Boston, Massachusetts |
| 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. |
| Disease/Diagnosis |
Intracranial hypotension plus posterior cortical atrophy (visual variant Alzheimer's). |
| Date |
2021-02 |
| References |
1. Ortega-Porcayo LA, Ortega EP, Quiroz-Castro O, Carrillo-Meza RA, Ponce-Gomez JA, Romano-Feinholz S, Alcocer-Barradas V, de Velasco AR, Zazueta MO. Frontotemporal brain sagging syndrome: Craniospinal hypovolemia secondary to a T6-T7 cerebrospinal fluid-venous fistula. Surg Neurol Int. 2020 Aug 15;11:250. doi:10.25259/SNI_401_2020. PMID: 32905237; PMCID: PMC7468191. 2. Farb RI, Nicholson PJ, Peng PW, Massicotte EM, Lay C, Krings T, terBrugge KG. Spontaneous Intracranial Hypotension: A Systematic Imaging Approach for CSF Leak Localization and Management Based on MRI and Digital Subtraction Myelography. AJNR Am J Neuroradiol. 2019 Apr;40(4):745-753. doi: 10.3174/ajnr.A6016. Epub 2019 Mar 28. PMID: 30923083; PMCID: PMC7048504. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
53rd Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2021 |
| 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 2021. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6p61mtc |
| Setname |
ehsl_novel_fbw |
| ID |
1697342 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6p61mtc |
