Are We "Tilting At Windmills"? (Slides)

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Identifier walsh_2020_s1_c3-slides
Title Are We "Tilting At Windmills"? (Slides)
Creator Michael Vaphiades, DO
Subject Tuberculosis, Meningitis
History A 52-year-old African American woman presented to her primary care physician with a 4 week history of headaches, nausea, vomiting, fever and ataxia. Her medical history includes rheumatoid arthritis, hypertension and a recent diagnosis of pulmonary; sarcoidosis for which she was taking 20 mg of prednisone daily. Her general medical and neurologic examination was normal. A chest x-ray was normal and an MRI Brain without contrast showed numerous small abnormal foci with surrounding FLAIR hyperintensity, some of which were ring shaped. The patient was admitted to the hospital, broad spectrum antibiotics were initiated, she became confused and developed respiratory compromise requiring intubation. Her confusion soon gave way to seizures, stupor and coma. A contrasted head CT showed that the lesions were enhancing and some in a ring like fashion. The; superior ophthalmic veins now appear enlarged concerning for cavernous sinus thrombosis. Bedside examination showed an intubated patient non-responsive to external stimuli. The patient's eyes were directed in primary position and lids were closed. She had marked proptosis with inferior conjunctival chemosis and facial swelling. No corneal reflexes present. Exophthalmometry measured 33 mm OU with base of 115 mm. Intraocular pressures measured 36 mm Hg OD, 35 mm Hg OS and latanoprost was prescribed. Labs show an elevated WBC of 16.7 with 95% neutrophils, normal H/H and platelets. BMP normal. ESR 46, CRP 115.30 mg/L, RPR NR, blood cultures negative. PPD skin test was nonreactive. HIV negative. Lumbar puncture showed 25 WBC, 78 RBC, glucose 83 mg/dL (40-75), protein 57 mg/dL (18-53), no AFB, cryptococcal antigen negative, PCR for herpes virus negative. Flow cytometry analysis shows that 70% of total cells are lymphocytes. Contrasted CT chest and abdomen showed necrotic adenopathy in the right axilla along with multiple indeterminate subcentimeter hypodensities within the liver parenchyma. A diagnostic procedure; was performed.
Relation is Part of NANOS Annual Meeting 2020: Frank B. Walsh Session 1
Contributor Primary Michael Vaphiades, DO
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/s69d28pg
Setname ehsl_novel_fbw
Date Created 2020-05-15
Date Modified 2020-05-15
ID 1551236
Reference URL
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