Jacqueline A. Leavitt, John J. Chen, Diva R. Salomao
Subject
Vision loss, Field loss, Fatigue, Intracranial Tumor
History
A 29 year-old female nurse, nine months postpartum, presented with an inability to see her computer well for the past two months. She denied eye pain, diplopia, numbness, tingling or weakness. There were no changes in vision in bright vs. dim lighting. She also had a headache at the back of her head for two months that was relieved with OTC medications. She denied any events immediately preceding the blurred vision. She also complained of shortness of breath, unexplained weight loss and extreme fatigue, sleeping 10 hours per night and taking naps over her lunch break at work. Workup by her primary care doctor revealed a normal CXR, ECG with sinus bradycardia and anemia (Hgb 9.6, Hct 28.7). Towards the end of her recent pregnancy she was evaluated for polydipsia (drinking up to 9 L /d) and nocturia (6- 7 x /night). Water deprivation testing during pregnancy was not possible but sodium of 133 made the diagnosis of diabetes insipidus (DI) unlikely. Symptoms improved after delivery and therefore the polyuria and polydipsia was attributed to pregnancy. Postpartum she also developed fairly severe anxiety and depression that was managed with sertraline and clonazepam. On examination, best corrected visual acuity was 20/30 OU, Ishihara color plates were 11/13 OD, 13/13 OS. Pupils reacted briskly without an RAPD. Visual fields were full to confrontation. Slit lamp and dilated fundus examination was unremarkable, including absence of macular abnormalities or optic disc pallor. Goldmann fields showed a suggestion of a homonymous field defect, but had variable responses and the perimetrist noted that she was often falling asleep during the test. Optical coherence tomography showed a normal average retinal nerve fiber layer thickness OU. Lab workup showed an elevated ESR of 70 and an elevated ACE of 62.Tests were performed.
Date
2015
Language
eng
Format
video/mp4
Type
Image/MovingImage
Relation is Part of
NANOS Annual Meeting Frank B. Walsh Sessions; 2015
