| Identifier |
walsh_2018_s3_c3-2 |
| Title |
Light at the End of the Tunnel - Slides |
| Creator |
Noel Chan; Tak Lap Poon; Joyce Chow; Wai Lun Poon; Sherman Lo; Wing Hung Lau; Ka Hong Au; Carmen Chan |
| Affiliation |
(NC) (CC) Neuro-Ophthalmology Service, Hong Kong Eye Hospital, Hong Kong, Hong Kong; (TLP) (JC) Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, Hong Kong; (WLP) (SL) Department of Radiology & Imaging, Queen Elizabeth Hospital, Hong Kong, Hong Kong; (WHL) Department of Pathology, Queen Elizabeth Hospital, Hong Kong, Hong Kong; (KHA) Department of Ophthalmology, United Christian Hospital, Hong Kong, Hong Kong |
| Subject |
Optic Neuropathy; Tumor |
| History |
A 24-year-old Chinese man presented with 1-year history of progressive blurring of vision of the right eye. He had no significant past ocular nor medical history except moderate myopia and migraine. On ophthalmologic examination, his corrected visual acuity at distance was 20/100 OD and 20/30 OS. Ishihara OD failed test plate, OS 3/14. Ocular examination, including intraocular pressure, was normal, except the finding of bilateral disc pallor with enlarged cup-disc ratio of 0.9 OD and 0.7 OS. Visual field examination showed OD general depression and OS tunnel vision. OCT retinal nerve fiber layer analysis confirmed optic atrophy OU. MRI brain and orbit with contrast did not show any optic nerve abnormalities, but there were abnormal T2 hyperintensities at the genu of corpus callosum and the adjacent white matter, which were commented as highly suggestive of demyelinating disease. Other investigations including C-reactive protein, anti-nuclear antibody, rheumatoid factor, vitamin B12, folate levels were all normal. Neuromyelitis optica antibody was not found. Lumber puncture showed CSF white cell count of 13 (99% lymphocyte), and oligoclonal bands were present. Alpha-fetoprotein (AFP) and beta- human chorionic gonadotropin (b-HCG) levels, in serum and CSF, were normal. Multiple sclerosis was suspected, and intravenous steroid therapy was considered, but withheld since the diagnosis was not certain and there was no definite evidence of acute deterioration. When reviewed 2 months after initial presentation, his visual acuity had dropped to 20/400 OS and 20/100 OS. In view of the rapidly deteriorating visual acuity, the MRI was reviewed. It was felt the nodular ependymal and hypothalamus/ pituitary stalk lesions were atypical for demyelination. A diagnostic procedure was performed. |
| Disease/Diagnosis |
Central nervous system (CNS) Germinoma (non-secreting) |
| Date |
2018-05 |
| References |
1. Jennings MT; Gelman R; Hochberg F. Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg.; 63(2):155-67, 1985 2. Fujimaki T, Matsutani M, Funada N, Kirino T, Takakura K, Nakamura O et al. CT and MRI features of intracranial germ cell tumors. J Neurooncol.;19(3):217-26, 1994. 3. Birnbaum T, Pellkofer H, Buettner U. Intracranial germinoma clinically mimicking chronic progressive multiple sclerosis. J Neurol.; 255(5):775-6, 2008. 4. Blakeley JO; Grossman SA. Management of pineal region tumors. Curr Treat Options Oncol.; 7(6):505-16, 2006. 5. Shibamoto Y. Management of central nervous system germinoma: proposal for a modern strategy. Prog Neurol Surg.; 23:119-29, 2009. |
| Language |
eng |
| Format |
application/pdf |
| Format Creation |
Microsoft PowerPoint |
| Type |
Text |
| Source |
2018 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2018 |
| 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 2018. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6gt9rgx |
| Setname |
ehsl_novel_fbw |
| ID |
1326605 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6gt9rgx |
