You're Too Young for That! (Slides)

Update item information
Identifier walsh_2020_s2_c2-slides
Title You're Too Young for That! (Slides)
Creator Sravanthi Vegunta, Kathleen Digre, Bradley Katz, Meagan Seay, Alison Crum, Edward Quigley, Sean Kennedy, Nick Mamalis, Judith Warner
Subject Autoimmune Diseases, 6th Nerve Palsy, Steroids, Sarcoidosis
History An 11-year old boy presented with right orbital pain for two months with recent double vision. He had no recent viral illnesses or sick contacts. He had no past medical history. His brother had Kawasaki disease; his paternal grandmother had rheumatoid arthritis; and his father died of a myocardial infarction at age 48. Our patient's exam showed only inability to abduct OD. Brain MRI showed dural thickening and enhancement along the right lateral cavernous sinus, right orbital apex, and tentorium. His lumbar puncture showed 6 white blood cells, 1 red blood cell, normal protein, glucose, and CSF ACE, and negative oligoclonal bands, gram stain, and cultures. The working diagnosis was Tolosa Hunt. He was started on high dose oral steroids with taper. Five months after initial presentation, he developed new right V2 numbness, complete right ophthalmoplegia, and weakness and numbness of his right hand and leg. These symptoms were again responsive to steroids. He had further workup that showed elevated ESR (44mm/hr), CRP (4.7mg/dL), and C4 (37mg/dL) while on oral steroids. He was hepatitis immune. Serum ACE, IgG4, B12, RF, ANA, quantiferon gold, VZV IgM, and cytometry were normal or negative. Repeat MRI brain showed decreased dural thickening. His symptoms resolved, and his disease was stable for 15 months. He returned with two weeks of left-sided headaches and acute diplopia, and on exam had; a left sixth nerve palsy. He also reported pain in his knees and ankles with mild swelling on exam. MRI Brain showed new hypertrophic pachymeningitis isolated to the right middle cranial fossa with slight extension superiorly overlying the lateral sulcus and frontal parietal junction. Extensive work up was negative: CSF Lyme, coccidioides, and aspergillus antibodies, meningitis/encephalitis PCR panel, CSF gram stain, culture, cytology, and cytometry, serum electrophoresis, dsDNA, RF, and lysozyme. A diagnostic procedure was performed.
Relation is Part of NANOS 2020: Frank B. Walsh Session 2
Contributor Primary Sravanthi Vegunta
Contributor Secondary Kathleen Digre, Bradley Katz, Meagan Seay, Alison Crum, Edward Quigley, Sean Kennedy, Nick Mamalis, Judith Warner
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:
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
Language eng
ARK ark:/87278/s622860b
Setname ehsl_novel_fbw
Date Created 2020-05-14
Date Modified 2020-05-14
ID 1551207
Reference URL
Back to Search Results