| Identifier |
walsh_2015_s2_c5-1 |
| Title |
It's Not Just a FAD (EHR Fatigue Syndrome) |
| Creator |
Jacqueline A. Leavitt; John J. Chen; Diva R. Salomao |
| Affiliation |
Mayo Clinic Rochester, MN |
| Subject |
Vision loss, Field loss, Fatigue, Intracranial Tumor |
| History |
A 29 year-old female nurse, nine months postpartum, presented with an inability to see her computer well for the past two months. She denied eye pain, diplopia, numbness, tingling or weakness. There were no changes in vision in bright vs. dim lighting. She also had a headache at the back of her head for two months that was relieved with OTC medications. She denied any events immediately preceding the blurred vision. She also complained of shortness of breath, unexplained weight loss and extreme fatigue, sleeping 10 hours per night and taking naps over her lunch break at work. Workup by her primary care doctor revealed a normal CXR, ECG with sinus bradycardia and anemia (Hgb 9.6, Hct 28.7). Towards the end of her recent pregnancy she was evaluated for polydipsia (drinking up to 9 L /d) and nocturia (6- 7 x /night). Water deprivation testing during pregnancy was not possible but sodium of 133 made the diagnosis of diabetes insipidus (DI) unlikely. Symptoms improved after delivery and therefore the polyuria and polydipsia was attributed to pregnancy. Postpartum she also developed fairly severe anxiety and depression that was managed with sertraline and clonazepam. On examination, best corrected visual acuity was 20/30 OU, Ishihara color plates were 11/13 OD, 13/13 OS. Pupils reacted briskly without an RAPD. Visual fields were full to confrontation. Slit lamp and dilated fundus examination was unremarkable, including absence of macular abnormalities or optic disc pallor. Goldmann fields showed a suggestion of a homonymous field defect, but had variable responses and the perimetrist noted that she was often falling asleep during the test. Optical coherence tomography showed a normal average retinal nerve fiber layer thickness OU. Lab workup showed an elevated ESR of 70 and an elevated ACE of 62.Tests were performed. |
| Disease/Diagnosis |
Langherhans cell histiocytosis involving the chiasm, hypothalamus and sacrum |
| Date |
2015-02 |
| References |
1. Writing Group of the Histiocyte Society. Histiocytosis syndromes in children. Lancet. 1:208-209, 1987. 2. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol. 17:3835-3849,1999. 3. Howarth DM, Gilchrist GS, Mullan BP, Wiseman GA, Edmonson JH et al. Langerhans cell histiocytosis: diagnosis, natural history, management, and outcome. Cancer. 85:2278-2290, 1999. 4. Grois NG, Favara BE, Mostbeck GH, Prayer D. Central nervous system disease in Langerhans cell histiocytosis. Hematol Oncol Clin North Am. 12:287-305, 1998. 5. Grois N, Flucher-Wolfram B, Heitger A, Mostbeck GH, Hofmann J et al. Diabetes insipidus in Langerhans cell histiocytosis: results from the DAL-HX 83 study. Med Pediatr Oncol. 24:248-256,1995. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
47th Annual Frank Walsh Society Meeting |
| 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/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6246 |
| Rights Management |
Copyright 2015. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6tq8z52 |
| Setname |
ehsl_novel_fbw |
| ID |
179284 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6tq8z52 |
