| Identifier |
walsh_2015_s4_c3 |
| Title |
Using Muscle |
| Creator |
Nagham Al-Zubidi; John E. Carter; Bundhit Tantawongski; Patricia Chevez-Barrios; Lyndon Tyler; Constance L. Fry |
| Affiliation |
(NA) (JEC) Department of Neurology, University of Texas Health Science Center San Antonio, TX; (JEC) (LT) (CLF) Department of Ophthalmology, University of Texas Health Science Center San Antonio, TX; (BT) Department of Radiology, University of Texas Health Science Center San Antonio, TX; (PC) Department of Pathology, Houston Methodist Hospital and Weill Medical College of Cornell University Houston, TX |
| Subject |
Anisocoria, Ocular Pain, MRI, Special Staining, Amyloidosis |
| History |
A 30- year-old Saudi female student with no past medical history presented an eight month history of progressive blurred vision primarily at near, anisocoria OS, and periocular discomfort with eye movements. Neuro-Ophthalmologic examination revealed best corrected visual acuity of OD 20/20 and OS 20/30. Color vision was OD 12/12 and OS 12/12. Automated threshold perimetry was normal. The pupils were 4 mm and normally reactive OD and 5 mm and minimally reactive OS. There was no relative afferent pupil defect (RAPD). The pupil was characteristic of absent sympathetic and parasympathetic input as may be seen in cavernous sinus lesions. The eyes were quiet. IOP was normal. Ocular motility examination was normal at initial evaluation but over the next 3 months she developed limited adduction and mild proptosis; other eye movements were normal throughout her 10 month course. Funduscopy was normal. Magnetic resonance imaging (MRI) of the brain and orbit with contrast revealed an enlarged left medial rectus and a linear enhancing structure running from the medial rectus muscle back to the superior orbital fissure and superior lateral wall of the cavernous sinus, believed to be an enlarged, enhancing third nerve. The following laboratory studies were performed and were negative or normal: Angiotensin-converting enzyme, lysozyme, T4, T3, TSH, thyroid stimulating immunoglobulin, thyrotropin binding inhibitory immunoglobulins, thyroid peroxidase antibody, serum protein electropheresis, cysticercosis antibodies, trichinella immunoglobulin G, and IgG4 immunoglobulin. A Quantiferon Gold test was sent three times before receiving a report that it was positive after all the above evaluation and the diagnostic procedure were complete. A diagnostic procedure was done |
| Disease/Diagnosis |
Orbital Amyloidosis Presenting as Extraocular Muscle Mass and Enhancing, Thickened Third Nerve |
| Date |
2015 |
| References |
1. Paula JS, Paula SA, Cruz AA, Chahud F. Superior oblique muscle amyloidosis mimicking myositis. Ophthal Plast Reconstr Surg. 2008;24(1):77-9. 2. Davies DR, Smith SE. Pupil abnormality in amyloidosis with autonomic neuropathy. J Neurol Neurosurg Psychiatry. 1999;67(6):819-22. 3. Banerjee S, Bogman J, Reuser TT. Amyloid deposition in the extraocular muscles. Orbit 1999; 18:105-6. 4. Massry GG, Marrison W, Hornblass A. Clinical and computed tomography characteristics of amyloid tumour of the lacrimal gland. Ophthalmology 1996; 103:1233-6. 5. Di Bari R, Guerriero S, Giancipoli G, Cantatore A, Sborgia G, Piscitelli D. Primary localized orbital amyloidosis: a case report. Eur J Ophthalmol. 2006;16(6):895-7. 6. Focal Orbital Amyloidosis Presenting as Rectus Muscle Enlargement: CT and MR Findings Kouichirou Okamoto, Jusuke Ito, Iwao Emura, Toshihiko Kawasaki, Tetsuya Furusawa, Kunio Sakai, and Susumu Tokiguchi. AJNR Am J Neuroradiol 1998;19:1799-1801 |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| 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 |
| ARK |
ark:/87278/s6642mbf |
| Setname |
ehsl_novel_fbw |
| ID |
179258 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6642mbf |
