Fire and Ice

Update Item Information
Identifier walsh_2019_s2_c1
Title Fire and Ice
Creator Mary Maher, Joah Aliancy, Gul Moonis, Angela Lignelli, Michael Kazim, Jeffrey Odel
Subject Autoimmune Diseases; Magnetic Resonance Imaging; Optic Nerve; Retina; Demyelinating Disease
Description A 14 year-old boy, with ADHD on amphetamine and dextroamphetamine, presented with headache and bilateral decreased vision. Seven days prior, he began experiencing bilateral non-positional frontal headache unresponsive to NSAIDS that did not wake him from sleep. Five days prior, he felt fatigued and noticed blurry vision and decreased color perception. He denied pain on eye movement and ocular tenderness. He was brought to medical attention when he no longer could see the food on his plate. He was camping in the Catskills one week before his headache began; he denied tick bites, fever, URI, nausea, vomiting, diarrhea and stiff neck but had a red, itchy rash on his dorsal foot. There was no history of hypertension, diabetes, heart disease, anemia or recent blood loss. He had no prior history nor a family history of headache. His acuity was HM OD and 20/500 OS, and no control AO/HRR color plates were seen. There were large dense cecocentral scotomas OU. A right RAPD was present. EOMS and saccades were intact. Slit lamp examination was unremarkable OU with normal tensions. There was disc edema and peri-papillary hemorrhages OU with a large peri-papillary cotton-wool spot OD. Retinal veins were engorged OU. MRI of the orbits showed enlarged, enhancing, tortuous orbital and prechiasmatic optic nerves, sparing the chiasm, with globe flattening. The brain was normal. Lumbar puncture opening pressure was 180 mm/H2O. There were 3 RBC in the CSF and 12 WBC with 95% lymphocytes, 3% monocytes, 1% neutrophils and 1% eosinophils. CSF glucose was 63, and protein was; 31. The CBC revealed a WBC of 10.9 with a differential of 65% neutrophils, 26% lymphocytes, 5% monocytes, 3% eosinophils and 1% basophils. Hemoglobin was 14.3. Hematocrit was 40.1. BUN was 14. Creatinine was 0.47. AST was 33. ALT was 13.
Date 2019-03
Language eng
Format video/mp4
Source 2019 North American Neuro-Ophthalmology Society Annual Meeting
Relation is Part of NANOS 2019: Frank B. Walsh Session 2
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 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6jh848x
Contributor Primary Mary Maher
Contributor Secondary Joah Aliancy, Gul Moonis, Angela Lignelli, Michael Kazim, Jeffrey Odel
Setname ehsl_novel_fbw
ID 1431956
Reference URL https://collections.lib.utah.edu/ark:/87278/s6jh848x
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