| Identifier |
walsh_2018_s3_c1 |
| Title |
Coming to a Rapid Conclusion - Video |
| Creator |
Leanne Stunkel, Namita Sinha, Nathan Kung, Robi Maamari, Cole Ferguson, Sonika Dahiya, George Harocopos, Gregory Van Stavern |
| Subject |
vasculopathy, retinopathy, headaches, Neurologic disorders, Outer retinopathies/White dot syndromes |
| Presenting Symptom |
A 21-year-old man presented to a retina specialist for 2.5 weeks of painless central vision loss OD. His initial examination was notable for visual acuity 20/200 OD and 20/20 OS. Fundus examination was significant for several macular areas of retinal pigment epithelial (RPE) atrophy with associated subretinal whitening. Fundus autofluorescence showed further areas of RPE atrophy centrally and temporally. OCT of the macula showed areas of atrophy of the RPE with adjacent areas of hyperreflectivity and showed choroidal thickening in the involved area. Fluoroscein angiogram showed well-circumscribed regions of early hypofluorescence and adjacent regions of transmission defects and late hyperfluorescence. The working diagnosis was acute retinal necrosis, and the patient was offered admission for IV antivirals. When we declined admission, he was started on oral valacyclovir. About 10 days later, he developed a new, frontal headache, followed a few days later by involvement of the other eye (OS).;Funduscopic examination showed a new small area of whitening just inferior to the fovea OS. He was admitted to an outside hospital for IV and intravitreal antivirals. An infectious work-up was negative. At that time, he was started on prednisone 80mg daily out of concern for inflammatory etiology. However, his vision continued to decline to count fingers OD with examination notable for a new relative afferent pupillary defect OD and a new inferonasal visual field deficit OS. He continued to have worsening headaches. Approximately 1 week later he had sudden complete loss of vision OD and began to have hallucinations. His mental status declined and he had abnormal limb movements. He was intubated for airway protection. His examination without; sedation was notable for hypertension, bradycardia, unresponsiveness, fixed 8mm pupils bilaterally, intact oculocephalic reflexes, intact corneal reflexes, intact cough and gag reflexes, overbreathing the ventilator, and extensor posturing in response to noxious stimuli. |
| Date |
2018-03 |
| Language |
eng |
| Format |
video/mp4 |
| Source |
2018 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting 2018: Frank B. Walsh Session 3 |
| Collection |
Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416 |
| Rights Management |
Copyright 2018. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6h45v17 |
| Contributor Primary |
Leanne Stunkel, MD |
| Setname |
ehsl_novel_fbw |
| ID |
1320254 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6h45v17 |
