| Identifier |
walsh_2014_s3_c3-2 |
| Title |
More Than a Cu-bit of Vision Loss |
| Creator |
Philip M. Skidd; Rebecca C. Stacy; Waqar Waheed; Mohamed-Ali Babi |
| Affiliation |
(PMS) University of Vermont College of Medicine/Ophthalmology Burlington, VT; (PMS) (WW) (MB) University of Vermont College of Medicine/Neurological Sciences Burlington, VT; (RCS) Massachusetts Eye and Ear Infirmary/Ocular Pathology Boston, MA; (RCS) Massachusetts Eye and Ear Infirmary/Neuro-Ophthalmology Boston, MA |
| Subject |
Polyangiitis; Granulomatosis; ANCA Positive Vasculitis; Posterior Ischemic Optic Neuropathy; Meningitis; Anti-proteinase 3 Antibodies |
| History |
A 45 year-old, right-handed, man, presented after awakening with no vision in his left eye. Two days earlier he had experienced a brief episode of binocular horizontal, and then oblique, diplopia. One week prior, he developed left facial numbness and "sinus pain" on the same side; a five day course of azithromycin did not improve his symptoms. The patient's medical history included only a migratory arthritis previously labeled ankylosing spondylitis. He had been treated with steroids, hydroxychloroquine, and sulfasalazine, but was off all medications at the time of the vision loss. Review of systems was positive for unexplained 20 pound weight loss over three months, night sweats, and chills. He also had developed a raised nodule on each elbow, one from which he expressed "pus," several weeks prior to his vision loss. He had a 20 pack-year history of cigarette use and occasionally used alcohol and marijuana. The family history and remainder of the social history were non-contributory. Neuro-ophthalmic examination showed the external appearance of the eyes and face to be normal. The vision was 20/20 with full color OD; no light perception OS. There was a relative afferent pupillary defect on the left; with no anisocoria or ptosis. There were full ductions OD; limited adduction (-4), elevation (-3) and infraduction (-1), with slow abduction OS. The anterior segments were normal. The right optic nerve was normal; on the left the nerve was slightly full with attenuated vessels. There was anesthesia of the face in the distribution of V2 on the left. Initial laboratory studies showed thrombocytosis (605), ESR of 38 and CRP of 5.4 (<0.7 normal). MRI was obtained. Lumbar puncture returned normal opening pressure and CSF composition. Further laboratory tests and a procedure were performed. |
| Pathology |
Polyangiitis; Granulomatosis Meningitis |
| Disease/Diagnosis |
Polyangiitis with granulomatosis meningitis. |
| Presenting Symptom |
A 45 year-old, right-handed, man, presented after awakening with no vision in his left eye. |
| Neuroimaging |
Magnetic Resonance Imaging |
| Date |
2014-03 |
| References |
1. Thiel, Shakeel, Ah-See. Wegener's granulomatosis presenting as meningitis. J Laryngol Otol. 126(2):207-9; 2012. 2. Rothschild, et al. Ophthalmologic manifestations of systemic necrotizing vasculitides at diagnosis: a retrospective study of 1286 patients and review of the literature. Semin Arthritis Rheum. 42(5):507-14; 2013. 3. Drooger, Dees, Swaak. ANCA-Positive Patients: The Influence of PR3 and MPO Antibodies on Survival Rate and The Association with Clinical and Laboratory Characteristics. Open Rheumatol J. 3: 14-17; 2009. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
46th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2014 |
| 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 2014. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s62j98f6 |
| Setname |
ehsl_novel_fbw |
| ID |
179228 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s62j98f6 |
