| Identifier |
walsh_2014_s4_c3 |
| Title |
I Can't Stand the Double Vision |
| Creator |
Iris B. B. Mizrachi, Ruth Huna-Baron, Rivka Inzelberg, Yonathan Sharabi |
| Subject |
Myashtenia; Addies Pupil; Autonomic Dysfunction; Autoimmune |
| History |
A 37 year-old woman was referred to our clinic due to bilateral ptosis and vertical binocular diplopia. She denied diurnal variations, muscle weakness or bulbar symptoms. In the past year she had been suffering from bouts of abdominal pain, diarrhea, and severe weight loss (>40 pounds), and she presented a few times with bowel obstructions. She underwent partial resection of the ileum and was treated with total parenteral nutrition and later on with percutaneous endoscopic gastrotomy (PEG).Her past medical history was significant for uncontrolled hypothyroidism. Familial history was positive for Crohn's disease in her brother and myasthenia gravis in her father. On presentation to our clinic she was cachectic and very weak with difficulty standing. Visual acuity was 20/20 in both eyes, color vision and visual fields were normal in both eyes. She had 2 mm ptosis of her left upper eye lid without fatigue nor a change in eyelid position after 45 min rest. Pupils were 3 and 4 mm with sluggish reaction and light-near dissociation with no APD. Extraocular movements were full with right hypertropia, not consistent with a pattern of trochlear nerve palsy and no change after rest test. Fundoscopy was normal. Slit lamp examination demonstrated iris streaming and tear film insufficiency which was confirmed by Schirmer test. |
| Disease/Diagnosis |
Autonomic autoimmune gangliopathy in conjunction with myasthenia gravis. |
| Presenting Symptom |
A 37 year-old woman was referred to our clinic due to bilateral ptosis and vertical binocular diplopia. |
| Neuroimaging |
Magnetic Resonance Imaging |
| Date |
2014-03 |
| References |
1. Vernino S, Hopkins S, Wang Z, Autonomic ganglia, acetylcholine receptor antibodies, and autoimmune gangliopathy, Auton Neurosci 146, 3-7, 2009 2. Seropositive myasthenia and uatoimmune autonomic gangliopathy: cross reactivity or subclinical disease?, Miglis MG, Racela R, Kaufmann H, Auton Neurosci 164, 87-88, 2011. 3. Coexistent autoimmune autonomic gangliopathy and myasthnia gravis associated with non-small-cell lung cancer, Peltier A, Black BK, Raj SR, Donofrio P,Robertson D et al, Muscle Nerve 41,416-419, 2009. |
| Language |
eng |
| Format |
application/pdf |
| Type |
Image |
| Source |
46th Annual Frank Walsh Society Meeting |
| Relation is Part of |
Case presented at the NANOS 2014 Walsh Session, March 2 |
| 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 84112-6269 |
| Rights Management |
Copyright 2014. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s62n7zv4 |
| Setname |
ehsl_novel_fbw |
| ID |
179197 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s62n7zv4 |
