| Identifier |
walsh_2015_s1_c2 |
| Title |
A Shot in the Dark |
| Creator |
Joshua Pasol; Ricardo Komotar; Feisal Yamani |
| Affiliation |
(JP) Bascom Palmer Eye Institute Miami, FL; (RK) (FY) University of Miami Miller school of Medicine Miami, FL |
| Subject |
Optic Neuropathy, Autoimmune Diseases, Cupped Optic Nerve, MRI, Visual Field |
| Description |
Given his complaints and VF findings, a full field ERG was performed which showed no evidence of rod dysfunction or CAR/MAR. The dx of NTG was made given cupping and VF constriction. However, an MRI was ordered which revealed pachymeningeal thickening with enhancement around both optic nerves and a mass in the foramen magnum. A spinal tap revealed normal pressure, CSF protein of 370 mg/dL, normal glucose, 45 WBC with 95% lymphs. Flow and cytology were negative for malignancy or monoclonality. Numerous lab tests were negative for any inflammatory disease (ACE, ANCA, RPR, SPEP, SSa/SSb, ANA, RF, Beta-2 microglobulin, PSA). A biopsy of the foramen magnum lesion was performed and it revealed: 'dense fibrosis with inflammatory cells containing T and B lymphocytes and plasma cells without any evidence of lymphoma'. The diagnosis of an inflammatory pachymeningitis was made. He was given oral prednisone with improvement of the visual field. |
| History |
A 74 year-old man with a chief complaint of difficulty with night time driving for several years as well as difficulty going from a lighted room to a dark room. PMH of high cholesterol, BPH, hypothyroidism, GERD, glottic squamous cell cancer without recurrence, and a prior history of alcoholism. POHx: cataract extraction right eye and AMD. Medications include Multivitamin, Aspirin, Synthroid, Tamsulosin, Omeprazole, Crestor. Drinks wine intermittently and stopped drinking after possible DT's. He owns a bar. His initial exam VA: 20/25 OU, normal IHCP, CFVF: OD constricted, OS normal. Pupils with no APD but were sluggish. IOP's 13 mm Hg OU. Motility showed some slight decreased abduction OU: 5ET primary, 10ET left, 5ET right gazes. SLE: PCIOL OD, NS cataract OS. Optic nerves had 0.7 cups with difficulty in appreciating any pallor. He had a few RPE macular changes OU. The HVF appeared reliable with severe constriction OD>OS (MD -29 and -17 respectively). RNFL OCT showed a mean thickness of 69 and 61 microns respectively. Testing was later done. |
| Disease/Diagnosis |
Idiopathic Hypertrophic Pachymeningitis mimicking Normal Tension Glaucoma Visual Field loss |
| Date |
2015-02 |
| References |
None. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
47th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting 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 |
| Rights Management |
Copyright 2015. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6cp01hz |
| Setname |
ehsl_novel_fbw |
| ID |
179272 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6cp01hz |
