| Identifier |
walsh_2015_s2_c3-2 |
| Title |
Growing Suspicion |
| Creator |
Angela M. Herro |
| Subject |
Optic neuritis; Sarcoidosis; Meningioma; Steroid-resistant |
| History |
A 44 year-old man presented to the emergency department in July 2011 for progressive painless visionloss in the right eye for 3 months. On presentation, vision was 4/200 in the right and 20/20 in the leftwith an afferent pupillary defect on the right. His visual field was full to confrontation but automatedperimetry revealed a central scotoma. The remainder of the exam was normal with the exception ofslight elevation of the optic nerve head along with mild perivascular sheathing. He received IVsolumedrol for 3 days followed by an oral steroid taper. Fat saturated MRI did not show enhancement ofthe optic nerve nor any brain abnormalities or mass lesions. He had a normal lab workup includingCBC, BMP, quantiferon gold, B12, RPR, and ACE and a normal CXR. On follow up one month later,he experienced no vision improvement. At this point, testing for Lebers hereditary optic neuropathy(LHON) was performed and was negative. He returned 6 months later with subjective worsening ofvision in the right eye, however acuity was stable at 4/200. He was started on IVIg therapy andautoimmune and NMO antibodies were drawn. Antibody testing was negative and on follow up onemonth later, his acuity remained unchanged and his scotoma was larger and denser. He was again lost tofollow up for 3 years until he began losing vision in the left eye. Exam revealed counting fingers visionin the right eye and 20/40 with a temporal visual field defect in the left eye. MRI showed an enhancingmass extending from the planum tuberculum and suprasellar area to the right temporal lobe and intoboth orbits. A procedure was performed. |
| Disease/Diagnosis |
Meningeal sarcoidosis masquerading as en plaque meningioma with intraseptal cardiac involvement |
| Date |
2015-02 |
| References |
1. Delaney P. Neurologic manifestations of sarciodosis: review of the literature with a report of 23 cases. Ann Intern Med 197787:336-46. 2. Ranoux D, Devaux B, Lamy C, Mear JY, Roux FX, and JL Mas. Meningeal sarcoidosis, pseudo-meningioma, and pachymeningitis of the convexity. J Neurol Neurosurg Psychiatry. 1999 55:300-303. Walport MJ et al. Meningeal granulomas: Sarcoidosis or tuberculosis? British Medical Journal, International edition. 1995:517. 3. Vorselaars AD, et al. Current Therapy in Sarcoidosis, the Role of Existing Drugs and Future Medicine. Inflamm Allergy Drug Targets. 2013 Dec12(6):368-77. |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| Source |
47th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2015 |
| 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 84112-6211 |
| Rights Management |
Copyright 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6sr1x17 |
| Setname |
ehsl_novel_fbw |
| ID |
179292 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6sr1x17 |
