Christine Greer, Jasmine Francis, Eli Diamond, Charles Eberhart, Marc Dinkin
Subject
Optic Neuritis, MRI, Horizontal Gaze Palsy
History
A 34-year-old man with a past medical history of bilateral corneoscleral lesions and brainstem, thalamic, and temporal lobe lesions presented with progressive vision loss over seven months. He described graying out of vision with light sensitivity. Bilateral, retrobulbar, deep ocular pain started 2 months ago but otherwise he denied headache. He endorsed baseline foreign body sensation. His ophthalmologic exam was notable for bilateral count fingers vision, normal IOP, pupils were round and reactive with no rAPD. His extraocular motility was significant for a bilateral gaze palsy. His slit lamp exam was notable for a gelatinous infiltrate circumferentially around the corneal limbus nasally on the right eye and 360 degrees around the left, but the visual axis remained clear. He had grade two posterior subcapsular cataracts and his dilated fundus exam was notable for diffusely pale optic nerves with; a normal cup-to-disc ratio of 0.3. Cranial nerves III-XII were otherwise intact. On neurologic exam, he was oriented to person, place, time. His recent and remote memory was intact. He exhibited a normal fund of knowledge and awareness of current events. His speech fluency difficult to assess because of profound dysarthria. Sensation was normal to light touch. Motor exam was significant; for L arm 3/5 in deltoid 4/5 triceps and 1 in wrist and fingers. Coordination was poor, patient could not perform finger to nose. Reflexes were 3+ throughout, with the exception of 4+ with clonus in the left patella. The left toe was upgoing. MR orbits showed enhancement of bilateral optic nerves with edema and enhancing lesions were present within the pons and the left mesial temporal lobe. He was admitted for workup and intravenous steroids.
Date
2020-03
Language
eng
Format
video/mp4
Source
2020 North American Neuro-Ophthalmology Society Annual Meeting