| Identifier |
walsh_2013_s3_c1 |
| Title |
Sacramentum Gladiatorium |
| Creator |
Michael Vaphiades; Jennifer Doyle |
| Affiliation |
University of Alabama/Ophthalmology, Birmingham, AL |
| Subject |
Optic Nerve; Headaches; Giant Cell Arteritis; Magnetic Resonance Imaging; Sphenoid Sinusitis |
| Description |
An 84-year-old woman with headache, acute visual loss and elevated ESR and CRP. A left temporal artery biopsy showed only atherosclerotic changes, no evidence GCA. MRI showed a left sphenoid sinus mucocele compressing the optic nerve and endoscopic sinus surgery revealed pus surrounding the left optic nerve and destroying optic canal. Culture showed abundant methicillin resistant staphylococcus aureus. She was prescribed clindamycin and sulfamethoxazole/trimethoprim as well as high-dose steroids. Remarkably the post-operative vision improved from NLP to 20/25 OS. |
| History |
Medical history includes hypertension and hyperlipidemia. |
| Pathology |
Culture showed abundant methicillin resistant staphylococcus aureus. |
| Disease/Diagnosis |
Sphenoid sinus mucocele induced optic neuropathy (methicillin resistant staphylococcus aureus) |
| Clinical |
Visual acuity is 20/30 OD and no light perception OS. Color vision is 4 of 8 OD and 0 of 8 plates OS. Confrontational fields are full in the right and nonplottable OS. Pupils measure 7mm in each eye with 2+reactivity in the right and no reactivity in the left with greater than 1.2 Log RAPD OD. She has decreased temporal artery upstroke bilaterally. |
| Presenting Symptom |
An 84-year-old woman who noted a headache for 2 weeks and a one day history visual loss OS. |
| Neuroimaging |
MRI |
| Treatment |
Clindamycin; Sulfamethoxazole/Trimethoprim |
| Date |
2013-02 |
| References |
1. VaphiadesMS, Yunker JJ, Roberson GH, Meyer DR, Mills DM. Optic neuritis is nothing to sneeze at. Surv Ophthalmol. 2007;52:106-110. 2. VaphiadesMS, Roberson GH. Sphenoid sinusmucocele presenting as a third cranial nerve palsy. J Neuroophthalmol. 2005;25:293-294. 3. VaphiadesM, Golnik KC. Optic neuropathy from bacteria. Int Ophthalmol Clin. 2007 ;47:25-36. 4. Lee AG, Lin DJ, Kaufman M, Golnik KC, Vaphiades MS, Eggenberger E. Atypical features prompting neuroimaging in acute optic neuropathy in adults. Can J Ophthalmol. 2000;35:325-330. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
45th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting 2013 |
| 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/s61k27dq |
| Setname |
ehsl_novel_fbw |
| ID |
179236 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s61k27dq |
