Objects Jumping, Body Bumping, Hearing Slumping…Quick, He is Crumping (Slides)

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Identifier walsh_2020_s1_c4-slides
Title Objects Jumping, Body Bumping, Hearing Slumping…Quick, He is Crumping (Slides)
Creator Jorge Kattah, Scott Eggers, Sarah Bach
Subject Eye Movements, Autoimmune Diseases, Neurologic Disorders, Nystagmus, Vestibular Ocular System
History A 45 y/o man developed insidious unsteadiness and bilateral hearing impairment. A neurosurgeon diagnosed possible myelopathy, and despite an anterior cervical discectomy, he noted progressive gait difficulty, poor handwriting, and inability to play the guitar. Additionally, dysarthria, oscillopsia and dizziness with rapid head movement developed. He had ~ 40% sensorineural hearing loss in his left ear, and eventually hearing loss in his right ear. When we first saw him, he used a walker at home, but had frequent falls. Finally, he had disabling episodes of vertigo, nausea and vomiting about twice per month, lasting several hours at a time. His PMH was significant for testicular seminoma, s/p resection in 2007, (left orchiectomy), and had normal oncologic monitoring in July 2017. Family history of ataxia or hearing loss was negative. He did not drink alcohol. The exam showed limb and truncal ataxia, dysarthria, primary gaze downbeat nystagmus, saccadic pursuit and bilateral decreased hearing with normal VOR. A head MRI (pre and postcontrast was normal). He had a chest/abdomen and pelvis CT scan that showed two enlarged lymph nodes, one periaortic (2 x 2.2 cm), and one near the left renal artery (3 x 1, 8 cm). A biopsy showed small lymphocytes and a focus of non-necrotizing granulomatous inflammation, without evidence of carcinoma on H&E or pancytokeratin immunostains. CD68 identified hystiocytes (non-necrotizing granulomatous inflammation). Staining of the tissue after the pathologist became aware of the seminoma history showed rare seminoma cells and immunostaining with OCT4 was positive, leading to final diagnosis of "metastatic seminoma" CSF examination showed 13 white cells (all lymphocytes), protein: 28.56 mg/dL, and glucose: 50 mg /dL there was no local IGG synthesis and no oligoclonal bands. The anti-Ma antibody was negative, 14-3-3 protein level was 2 ng/mL (normal). A paraneoplastic panel performed at the Mayo Clinic was negative.
Relation is Part of NANOS 2020: Frank B. Walsh Session 1
Contributor Primary Jorge C. Kattah, MD
Contributor Secondary Scott Eggers, Sarah Bach
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2020-03
Format application/pdf
Source 2020 North American Neuro-Ophthalmology Society Annual Meeting
Rights Management Copyright 2020. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s69h1036
Setname ehsl_novel_fbw
Date Created 2020-05-14
Date Modified 2020-05-14
ID 1551205
Reference URL https://collections.lib.utah.edu/ark:/87278/s69h1036
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