Systemic Disorders With Optic Nerve and Retinal Findings

Update item information
Identifier 92_51
Title Systemic Disorders With Optic Nerve and Retinal Findings
Subject Sarcoidosis; Papilledema
Description A 29-year-old African American woman presented with headaches, bilateral transient visual obscurations, blurred vision, numbness, and weakness of the lower extremities with myalgia and joint pains. She had an unplanned 12-pound weight loss over 2 months. A neurologist and internist diagnosed her with polymyalgia rheumatica, and placed her on prednisone 45 qod for this. Her past history included bronchitis. She had migraines, which led to a CT scan in 1986 and again in 1990, both reportedly normal. Her family history included two brothers who she said died of muscular dystrophy. The week before presentation, she was noted to have mild iritis OU. Her examination showed that she was 20/30 OD, 20/25 OS, Ishahira plates = 6.5/10 OD, 7/10 OD pupils 5/5 RRL, no APD. The motility and slit-lamp examination were normal. The field OD showed a nasal step, and an earlier inferior arcuate scotoma; the field OS had an early inferior arcuate defect. The fundi showed bilateral disk edema, OD>>OS. The MRI showed thickened and enhancing optic nerves, with prominent lacrimal glands, and enhancement of the seventh and eighth cranial nerves bilaterally . Her evaluation (on corticosteroids) was notable for ACE = 30 (normal), a chest x-ray demonstrating hilar adenopathy, and a gallium scan with increased hilar uptake bilaterally. The spinal tap showed glucose 54, protein 188, 0 RBC, 103 WBC (87% lymphs, 13% monos), oligoclonals (-) lgG 35-8 (<8.6), VDRL (-), and Lyme (-), a lacrimal biopsy was negative, she refused bronchoscopy, and the diagnosis was presumptive neurosarcoidosis. All signs and symptoms went away with 80 mg of prednisone followed by a slow taper.
Creator AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology Society
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Type Image
Format image/jpeg
Relation is Part of Case 47
Rights Management Copyright 2002. 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
Contributor Primary Larry P. Frohman, MD, UMDNJ-New Jersey Medical School
Source AAO/NANOS Clinical neuro-ophthalmology : image collection for ophthalmic practitioners. American Academy of Ophthalmology [electronic resource], [San Francisco, Calif.] : AAO, c1999.
ARK ark:/87278/s65m958b
Setname ehsl_novel_aao_nanos
Date Created 2004-11-17
Date Modified 2014-07-03
ID 176679
Reference URL
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