Bones of the Past (Slides)

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Identifier walsh_2020_s3_c4-slides
Title Bones of the Past (Slides)
Creator Bart K. Chwalisz, Konstantinos Douglas, Vivian Douglas, Otto Rapalino
Subject 6th Nerve Palsy, Skull Base, Pituitary Surgery (Transphenoidal Adenomectomy), PET
Description A 44-year-old woman presented with two episodes of binocular horizontal diplopia within one year. She had a history of Cushing's syndrome status post transsphenoidal resection and bilateral adrenalectomy 4 years prior, hypertension, and secondary diabetes mellitus. Nine months prior she developed severe right-sided headache and a right abducens nerve palsy, which improved over several weeks. At presentation, she described left-sided headache and neck pain, followed by development of horizontal diplopia worst on left gaze. She had normal visual acuity, color vision, visual fields, pupillary function, and fundi. There was an isolated left abduction deficit with incomitant esotropia. MRI of the brain with contrast showed stable residual postoperative findings in the sella, with unchanged residual contrast-enhancing pituitary tissue, and some contact of the left AICA with the left abducens nerve but no enhancement or other abnormality of the abducens nerves or extraocular muscles. A second radiologic opinion noted previously missed confluent but heterogeneous T1-hypointense marrow in the clivus with diffusion restriction, which in retrospect was progressively worsening over serial scans from preceding years. Lumbar puncture yielded normal cerebrospinal fluid. A CT PET of the skull base showed abnormal enhancing soft tissue within the sella and extending along the epidural surface of the clivus, and progression of bony sclerosis within the clivus compared to prior scans; there was hypermetabolism of the clivus. Follow-up MRI demonstrated progression of the changes in the sella and clivus compared to her postoperative imaging. Serum adrenocorticotropic; hormone (ACTH) levels were significantly higher than prior. A transsphenoidal biopsy revealed tumor with surrounding fibrotic reaction in the sella, sphenoid sinus and superior clivus. Pathology was consistent with corticotroph adenoma with elevated; proliferation index and scattered mitoses. A diagnosis of Nelson's syndrome was made. The patient underwent radiation therapy, with full resolution of her diplopia and headache.
Date 2020-03
Language eng
Format application/pdf
Source 2020 North American Neuro-Ophthalmology Society Annual Meeting
Relation is Part of NANOS Annual Meeting 2020: 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 2020. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6c01fvw
Contributor Primary Bart K. Chwalisz, MD
Contributor Secondary Konstantinos Douglas, Vivian Douglas, Otto Rapalino
Setname ehsl_novel_fbw
ID 1540462
Reference URL https://collections.lib.utah.edu/ark:/87278/s6c01fvw
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