(TB) Lifespan Physician Group, The Warren Alpert Medical School at Brown University, Providence, Rhode Island; (JG) Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
A 61-year-old woman, active smoker with history of COPD, presented with bilateral progressive vision loss and ataxia. Four months prior to her presentation she developed 'black spot' in her right eye (OD) and was found to have 'OD disc edema and right hypertropia' by an outside ophthalmologist. She was admitted to the hospital where she had a brain MRI that was interpreted as normal. Lumbar puncture showed elevated CSF white cells and protein. CSF cultures were negative. She was diagnosed with viral meningitis and treated supportively with subjective improvement of vision. Over the next three months she developed progressive bilateral vision loss and severe ataxia to the point that she was not able to ambulate without a walker. On presentation to our neuro-ophthalmology clinic, her best corrected visual acuities were 20/60-2 OD and 3/200 OS, she missed 6.5 Richmond color plates OD and was unable to see the control plate OS. She had a left relative afferent pupillary defect. Her extraocular motility was full, and she had downbeat nystagmus. The external and anterior segment exams were normal. On funduscopic exam, she had bilateral moderate optic disc edema. Automated perimetry showed an inferonasal defect OD and generalized depression OS. The rest of her neurological exam was notable for dysmetria with left heel-to-shin probe and severe swaying in all directions when standing. She was unable to take any steps due to imbalance.
Disease/Diagnosis
CRMP-5 paraneoplastic syndrome with bilateral optic neuropathy and cerebellar syndrome.
Date
2020-03
References
1. Antoine JC et al. J Neurol Sci: Jul 1993, Vol. 117(1-2): 215-23. 2. Cross SA et al. Ann Neurol. 2003 Jul; 54(1): 38-50
Language
eng
Format
video/mp4
Type
Image/MovingImage
Source
2020 North American Neuro-Ophthalmology Society Annual Meeting
Relation is Part of
NANOS Annual Meeting Frank B. Walsh Sessions; 2020
