| Identifier |
walsh_2021_s2_c4-slides |
| Title |
Orbiting a Diagnosis |
| Creator |
Daniel Liebman, Daniel Lefebvre, Emily Tam, Marie Lithgow, Bart Chwalisz, Eric Gaier, Joseph Kane |
| History |
A 68 -year-old right -handed man presented for evaluation of progressive and fluctuating polyopia, gait instability and cognitive changes of about 14 months. Prior medical history was notable for Crohn's disease in remission, atrial fibrillation, a single episode of aseptic meningitis 12 years prior, retinal detachment status post retinopexy and early macular degeneration. The neuro-ophthalmic examination showed visual acuities of 20/40 OD and 20/20 OS, and mild bilateral difficulty with Ishihara color plates. Goldmann visual field test showed bilateral mild constriction. Assessment of higher cortical visual function with the CORVIST battery showed significant difficulties with both basic occipital function and higher cortical visual functions. He also appeared to have more difficulty with right-sided than left-sided parietal function. 18F-FDG PET scan of the brain showed prominent lateral occipital, lateral parietal, and posterior temporal lobe hypometabolism bilaterally. Neuropsychological testing confirmed multidomain impairment most severely affecting visual processing. On initial MRI of the brain, diffuse smooth pachymeningeal contrast enhancement in the supra-and infra-tentorial compartments as well as mild tonsillar and central brain descent was demonstrated suggestive of intracranial hypotension. MRI of the cervical, thoracic, and lumbosacral spine disclosed no evidence of an extradural fluid collection to specifically suggest a CSF leak. A CT myelogram failed to reveal a CSF leak. Intracranial hypotension did not resolve with two empiric blood patches. Additional diagnostic studies were obtained. |
| Disease/Diagnosis |
Infiltrative perineuritis secondary to cryptococcal meningitis. |
| Date |
2021-02 |
| References |
(1) Kincaid, Green, 'Ocular and orbital involvement in leukemia', Surv Ophthalmol, Jan-Feb 1983; 27(4); 211-32. |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| Source |
53rd Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting 2021: Walsh Session II |
| 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 84112-5921 |
| Rights Management |
Copyright 2021. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6kt2qdw |
| Setname |
ehsl_novel_fbw |
| ID |
1694355 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6kt2qdw |
