| Identifier |
walsh_2019_s1_c3 |
| Title |
Chalky Pallid Edema |
| Creator |
Daniel Kornberg; David Pisapia; Cynthia Magro; Cristiano Oliveira; Marc Dinkin |
| Affiliation |
(DK) Weill Cornell Medical College/NewYork-Presbyterian, New York, New York; (DP) (CM) (CO) (MD) Weill Cornell Medical College, New York, New York |
| Subject |
Giant Cell Arteritis; Temporal Artery Biopsy; Ischemic Optic Neuropathy |
| History |
A 52 year-old woman with hypertension, insulin dependent type II diabetes, mild non-proliferative diabetic retinopathy in both eyes, obstructive sleep apnea, paroxysmal atrial fibrillation, obesity and multifactorial end-stage renal disease (ESRD) complained of four days of a dark scotoma in the inferior portion of the right eye that began right after hemodialysis. The scotoma migrated inferiorly and enlarged over four days. One month prior to presentation she developed intermittent jaw pain on chewing, worse on the right side. On ophthalmic examination, visual acuity was count fingers at three feet for the right eye and 20/60 with pinhole improvement to 20/25 in the left eye. There was a 2+ relative afferent pupillary defect (RAPD) in the right eye. The anterior segment examination was notable only for bilateral mild nuclear sclerosis. Fundus examination of the right eye showed 360° optic disc edema with chalky temporal pallor and a flame hemorrhage superior to the disc. The left optic disc was without edema or pallor with a 0.2 cup to disc ratio. In light of the presence of jaw claudication and pallid edema, an arteritic anterior ischemic optic neuropathy (AION) due to giant cell arteritis (GCA) was suspected. Fluorescence angiogram demonstrated leakage of the right optic disc with normal retinal and choroidal filling. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated to 90 mm/hr and 4.3 mg/dL, respectively, but platelet count was normal at 229 per uL. Brain MRI revealed several punctate acute infarcts across several vascular territories including the bilateral high frontal and left occipital white matter, as well as a punctate focus of restricted diffuse at the insertion of the right optic nerve head. Neck MRA showed no significant stenosis. Head MRA showed no signs of inflammation in the temporal artery walls. |
| Disease/Diagnosis |
AION of the right eye accompanied by jaw claudication, followed later by PION in the left eye, all secondary to calciphylaxis of branches of the common carotid artery. Concomitant bilateral punctate subcortical infarcts presumably a result of calciphylaxis as well. |
| Date |
2019-03 |
| References |
Nordborg E, Nordborg C. Giant cell arteritis: Epidemiological clues to its pathogenesis and an update on its treatment, Rheumatology 42(3), 413-21, 2003. Al-Absi AI, Wall BM, Cooke CR. Medial arterial calcification mimicking temporal arteritis. Am J Kidney Dis 44(4), 73-8, 2004. Sivertsen MS, Strøm EH, Endre KMA, Jørstad ØK. Anterior Ischemic Optic Neuropathy Due to Calciphylaxis. J Neuroophthalmol 38(1), 54-6, 2018. Roverano S, Ortiz A, Henares E, Eletti M, Paira S. Calciphylaxis of the temporal artery masquerading as temporal arteritis: a case presentation and review of the literature. Clin Rheumatol 34(11), 1985-8, 2015. Awwad ST, Ghosn S, Hogan RN. Calciphylaxis of the temporal artery masquerading as temporal arteritis. Clin Experiment Ophthalmol 38(5), 511-3, 2010. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
2019 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2019 |
| 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 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6b03p1g |
| Setname |
ehsl_novel_fbw |
| ID |
1431950 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6b03p1g |
