| Identifier |
walsh_2015_s3_c2-1 |
| Title |
A Weak Presentation |
| Creator |
Reuben M. Valenzuela, Bradley J. Katz, Alison V. Crum, Kathleen B. Digre, Nick Mamalis, Hans C. Davidson, Judith E. A. Warner, MD, Moran Eye Center, University of Utah |
| Subject |
Squamous Cell Carcinoma, Intraconal Orbital Mass, Intraconal Biopsy, Perineural Invasion |
| History |
An 82-year-old right-handed man with myasthenia gravis presented in May 2014 with double vision and right facial numbness and weakness. He was first seen in 1998 with horizontal diplopia. He had an abduction deficit of the right eye, and right nasolabial fold flattening. He was diagnosed with myasthenia based on a positive acetylcholine receptor blocking antibody. His chest CT scan was negative for thymoma. His diplopia and facial weakness resolved with azathioprine and prednisone. He had central retinal vein occlusion (CRVO) in the right in 2002, with resultant optic neuropathy and central vision loss. He had removal of innumerable squamous and basal cell carcinomas, coronary artery disease, prostate cancer with prostatectomy and laryngoplasty. In 2009, he first noticed right brow numbness. He had surgery for ectropion OD in April 2013. In May 2013, he developed dysesthesia of his right brow. A basal cell carcinoma was removed without benefit. In July 2013, his myasthenia was stable, but his azathioprine was decreased due to reduced platelets and hematocrit. In September 2013, he developed stabbing pain of his right cheek, with right cheek sensory loss and right facial weakness. A MRI in November 2013 showed a small enhancing intraconal mass, not in an MRI from 2006. In April 2014, he had Mohs excision of a poorly differentiated scalp squamous cell carcinoma. In May 2014, his afferent examination was stable. Eye movements showed new -2 limitation of abduction OD. He had sensory loss of his right cheek, and right facial weakness. Increasing his prednisone dose did not improve his eye movements. Repeat brain MRI in May 2014 showed increase in size of the orbital mass. The third, fourth, fifth, sixth, and seventh cranial nerves appeared normal. A diagnostic procedure was performed. |
| Disease/Diagnosis |
The final diagnosis is squamous cell carcinoma (SCCA) of the orbit with perineural invasion. |
| Date |
2015-02 |
| References |
1. Mehanna, H. M., John, S., Morton, R. P., Chaplin, J. M., & McIvor, N. P. (2007). Facial Palsy as the Presenting Compliant of Perineural Spread from Cutaneous Squamous Cell Carcinoma of the Head and Neck. ANZ Journal of Surgery, 191-193. 2. Nemec, S. F., Herneth, A. M., & Czerny, C. (2007). Perineural Tumor Spread in Malignant Head and Neck Tumors. Topics in Magnetic Resonance Imaging, 467-471. 3. Nemzek, W. R., Hecht, S., Gandour-Edwards, R., Donald, P., & McKennan, K. (1998). Perineural Spread of Head and Neck Tumors: How Accurate Is MR Imaging? American Journal of Neuroradiology, 701-706. 4. Nogajski, J., Brewer, J., & Sorey, C. (2006). Perineural spread of facial squamous cell carcinoma. Journal of Clinical Neuroscience, 400-403. 5. Roubeau, V., Diard-Detoeuf, C., & Moriniere, S. e. (2012). Clinical Reasoning: An unusual cause of multiple cranial nerve impairment. Neurology, e202-e205. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| 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 84112-6236 |
| Rights Management |
Copyright 2015. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s60g6gr8 |
| Setname |
ehsl_novel_fbw |
| ID |
179275 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s60g6gr8 |
