| Identifier |
walsh_2021_s1_c2-slides |
| Title |
Never Too Young or Too Old |
| Creator |
Bart Chwalisz; Laurel Tainsh; Mary Maher; Samantha Champion; Shuhei Nishiyima; Michael Levy |
| Affiliation |
(BC) Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts; (LT) Massachusetts Eye & Ear, Boston, Massachusetts; (MM) (SC) (SN) (ML) Massachusetts General Hospital, Boston, Massachusetts |
| Subject |
Neuromyelitis Optica Spectrum Disorder (NMOSD); Myasthenia Gravis; Optic Chiasm; Optic Neuritis |
| History |
An 81-year-old woman with history of ocular myasthenia gravis presented with sequential bilateral vision loss. Six days before presentation, she discovered that vision of her left eye was reduced to light perception. She did not have any eye pain, pain with eye movement, headache, scalp tenderness, jaw claudication, muscle soreness, rash, or joint aches. An ophthalmologist, documented no light perception vision with an afferent pupillary defect on the left, and a normal visual acuity on the right but visual field testing demonstrated a dense hemifield defect in the right eye. Dilated funduscopic exam was normal. A non-contrast brain MRI was reported as normal. CTA Head and Neck showed moderate to severe stenosis of one of the vertebral arteries. Erythrocyte sedimentation rate was 55 but due to absence of symptoms suggestive of temporal arteritis, she was not started on steroids but instead diagnosed with a stroke and treated with dual antiplatelet therapy. Four days later, the patient woke up with vision in the right eye severely diminished to the point of seeing only outlines and movement. The next day, vision worsened to bilateral no light perception. On examination, pupils were slightly reactive to light but there was a left afferent pupillary defect. The right and especially the left optic disc were felt to be slightly pale. IV steroids were started for suspected giant cell arteritis. An MRI brain and orbits with contrast revealed enlargement and enhancement of the bilateral proximal prechiasmatic optic nerves, optic chiasm, and proximal optic tracts with extension into the hypothalamus. MRI cervical and thoracic spine was normal. CSF was notable for no pleocytosis but a mildly elevated protein of 59 mg/dL, with negative CSF cytology and oligoclonal bands. Additional studies were obtained. Eight months later the patient died of an unrelated cause, and an autopsy was performed. |
| Disease/Diagnosis |
Optic neuritis and chiasmitis from aquaporin 4-seropositive neuromyelitis optica in an 81-year-old patient with myasthenia gravis. |
| Date |
2021-02 |
| References |
1. Borisow N, Mori M, Kuwabara S, Scheel M, Paul F. Diagnosis and Treatment of NMO Spectrum Disorder and MOG-Encephalomyelitis. Front Neurol. 2018 Oct 23;9:888. doi: 10.3389/fneur.2018.00888. PMID: 30405519; PMCID:PMC6206299. 2. Jarius S, Paul F, Franciotta D, de Seze J, Münch C, Salvetti M, Ruprecht K, Liebetrau M, Wandinger KP, Akman-Demir G, Melms A, Kristoferitsch W, Wildemann B. Neuromyelitis optica spectrum disorders in patients with myasthenia gravis: ten new aquaporin-4 antibody positive cases and a review of the literature. Mult Scler. 2012 Aug;18(8):1135-43. doi: 10.1177/1352458511431728. Epub 2011 Dec 19. PMID: 22183934. 3. Spillane J, Christofi G, Sidle KC, Kullmann DM, Howard RS. Myasthenia gravis and neuromyelitis opica: A causal link. Mult Scler Relat Disord. 2013 Jul;2(3):233-7. doi: 10.1016/j.msard.2013.01.003. Epub 2013 Feb 14. PMID: 25877729. |
| Language |
eng |
| Format |
application/pdf |
| Format Creation |
Microsoft PowerPoint |
| Type |
Text |
| Source |
53rd Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2021 |
| 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 2021. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6h190v4 |
| Setname |
ehsl_novel_fbw |
| ID |
1694315 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6h190v4 |
