| Identifier |
walsh_2015_s3_c4-2 |
| Title |
Who Deserves a Second Chance? |
| Creator |
Lina Nagia; Jennifer Doyle; Lanning Kline |
| Affiliation |
University of Alabama Birmingham/Department of Ophthalmology Birmingham, AL |
| History |
An 81-year-old woman presents with a one-month history of blurred vision OS, acutely worse in thepast 5 days. She reports pain with left gaze, left sided forehead tenderness and some weightloss. Medical history includes hypertension, borderline diabetes, cerebral vascular accident and basalcell carcinoma of the face. Her medications include rivaroxaban, metoprolol, atorvastatin andomeprazole. Visual acuity is 20/20 OD and light perception OS. Color vision is 11/11 OD and 0/11OS. Confrontational fields are full in the right eye and non-recordable in the left eye. Pupils arereactive and equal OU, with a greater than 1.2 log unit APD OS. Anterior segment exam revealsbilateral intraocular lenses. Dilated exam: OD is unremarkable, and OS is noted to have pallid discedema 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 orbitalportion of the left optic nerve. Prednisone 60mg/day is initiated for presumed GCA and temporal arterybiopsy scheduled. Contact is also made with the patients primary care physician to stop rivaroxaban. Aleft temporal artery biopsy showed calcific atherosclerosis, without evidence of active or treatedarteritis. Vision in left eye progressed to no light perception. Dedicated orbital MRI study with andwithout gadolinium showed mild enlargement and enhancement of the left optic nerve, possibly worsethan 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 dilatedexam 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 |
application/pdf |
| Format Creation |
Microsoft PowerPoint |
| Type |
Text |
| 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/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s60892xm |
| Setname |
ehsl_novel_fbw |
| ID |
179306 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s60892xm |
