| Identifier |
walsh_2015_s3_c4-1 |
| Title |
Who Deserves a Second Chance? |
| Creator |
Lina Nagia, Jennifer I. Doyle, Lanning B. Kline |
| History |
An 81-year-old woman presents with a one-month history of blurred vision OS, acutely worse in the past 5 days. She reports pain with left gaze, left sided forehead tenderness and some weight loss. Medical history includes hypertension, borderline diabetes, cerebral vascular accident and basal cell carcinoma of the face. Her medications include rivaroxaban, metoprolol, atorvastatin and omeprazole. Visual acuity is 20/20 OD and light perception OS. Color vision is 11/11 OD and 0/11 OS. Confrontational fields are full in the right eye and non-recordable in the left eye. Pupils are reactive and equal OU, with a greater than 1.2 log unit APD OS. Anterior segment exam reveals bilateral intraocular lenses. Dilated exam: OD is unremarkable, and OS is noted to have pallid disc edema with several hemorrhages. Initial blood work reveals an ESR 36mm/hr and CRP 5.4 mg/L (normal <3.0). MRI head obtained at outside facility showed abnormal enhancement along the orbital portion of the left optic nerve. Prednisone 60mg/day is initiated for presumed GCA and temporal artery biopsy scheduled. Contact is also made with the patient's primary care physician to stop rivaroxaban. A left temporal artery biopsy showed calcific atherosclerosis, without evidence of active or treated arteritis. Vision in left eye progressed to no light perception. Dedicated orbital MRI study with and without gadolinium showed mild enlargement and enhancement of the left optic nerve, possibly worse than prior. Patient admitted to hospital for workup. CT Chest - no evidence of sarcoidosis. LP - glucose 113 (serum 276), protein 31, WBC <1, cytology negative for malignant cells. Repeat dilated exam showed increased vitreous cells and debris in the left eye. A procedure was performed… |
| Disease/Diagnosis |
Left optic nerve diffuse astrocytoma, WHO grade II |
| Date |
2015-02 |
| References |
1. Wilhelm, Primary optic nerve tumours, Current Opinions in Neurology, 22(1);11-18, 2009 2. Cummings, Gliomas of the optic nerve:histological, immunohistochemical (MIB-1 and p53), and MRI analysis; Acta Neuropathol, 99;563-570, 2000 3. Shapiro, Malignant optic glioma in an adult: initial CT abnormality limited to the posterior orbit, leptomeningeal seeding of the tumor; Minnesota medicine, 65;155-159,1982 4. Wulc, Orbital optic nerve glioma in adult life, Archives of Ophthalmology, 107;1013-1016,1989 |
| 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 84112-6235 |
| Rights Management |
Copyright 2015. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6m64gxk |
| Setname |
ehsl_novel_fbw |
| ID |
179278 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6m64gxk |
