Look in the Back (Slides)

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Identifier walsh_2020_s1_c5-slides
Title Look in the Back (Slides)
Creator Tatiana Deveney, Aristides Capizzano, Jonathan Trobe
Subject Herpes Zoster (Zoster Ophthalmicus), Vasculitides, Magnetic Resonance Imaging, Thyroid Eye Disease
History A 59-year old man with Graves disease developed increasing proptosis and diplopia. Attributing these abnormalities to worsening of the Graves disease, an ophthalmologist treated him with high-dose oral and intravenous corticosteroids. When improvement did not occur, he underwent orbital x-irradiation (unknown dose). He developed new bilateral hearing loss, bilateral lower extremity weakness, and urinary retention eliciting catheter placement. Visual acuity declined, so he was referred to our institution for urgent orbital decompression. When we first encountered him, he was confused and drowsy. Best-corrected visual acuity was 20/80 in the right eye and 20/200 in the left eye. There was no afferent pupillary defect. External examination revealed marked proptosis. Extraocular motility was reduced in all directions. There was marked superficial punctate keratopathy bilaterally. Ophthalmoscopy through dilated pupils revealed multifocal white/yellow subretinal lesions without vitreous cells in both eyes. He had bilateral sensorineural hearing loss and bilateral lower extremity weakness with diminished lower extremity deep tendon reflexes. Orbital CT revealed bilaterally enlarged extraocular muscles with fullness at the orbital apex but no clear compression of the optic nerves. Brain MRI revealed diffuse intracranial leptomeningeal enhancement and enhancement of both auditory canals. Additionally, there was; restricted diffusion in the left fornix and right putamen. Spine MRI revealed enhancement of the cauda equina roots. Lumbar puncture showed a normal opening pressure with a white blood cell count of 578 (78% lymphocytes), a protein of 348 mg/dL, and negative cytology. The leading diagnosis was non-Hodgkin lymphoma (NHL). The putaminal and fornix abnormalities, believed to be; consistent with ischemic stroke, led to more detailed review of the brain MRI, which disclosed vessel wall enhancement of the right internal carotid artery. A procedure was performed.
Relation is Part of NANOS 2020: Frank B. Walsh Session 1
Contributor Primary Tatiana Deveney
Contributor Secondary Aristides Capizzano, Jonathan Trobe
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/s65r07b1
Setname ehsl_novel_fbw
Date Created 2020-05-14
Date Modified 2020-05-14
ID 1551206
Reference URL https://collections.lib.utah.edu/ark:/87278/s65r07b1