Nagham Al-Zubidi, John E. Carter, Bundhit Tantawongski, Patricia Chevez-Barrios, Lyndon Tyler, Constance L. Fry
Subject
Anisocoria, Ocular Pain, MRI, Special Staining, Amyloidosis
History
A 30- year-old Saudi female student with no past medical history presented an eight month history of progressive blurred vision primarily at near, anisocoria OS, and periocular discomfort with eye movements. Neuro-Ophthalmologic examination revealed best corrected visual acuity of OD 20/20 and OS 20/30. Color vision was OD 12/12 and OS 12/12. Automated threshold perimetry was normal. The pupils were 4 mm and normally reactive OD and 5 mm and minimally reactive OS. There was no relative afferent pupil defect (RAPD). The pupil was characteristic of absent sympathetic and parasympathetic input as may be seen in cavernous sinus lesions. The eyes were quiet. IOP was normal. Ocular motility examination was normal at initial evaluation but over the next 3 months she developed limited adduction and mild proptosis; other eye movements were normal throughout her 10 month course. Funduscopy was normal. Magnetic resonance imaging (MRI) of the brain and orbit with contrast revealed an enlarged left medial rectus and a linear enhancing structure running from the medial rectus muscle back to the superior orbital fissure and superior lateral wall of the cavernous sinus, believed to be an enlarged, enhancing third nerve. The following laboratory studies were performed and were negative or normal: Angiotensin-converting enzyme, lysozyme, T4, T3, TSH, thyroid stimulating immunoglobulin, thyrotropin binding inhibitory immunoglobulins, thyroid peroxidase antibody, serum protein electropheresis, cysticercosis antibodies, trichinella immunoglobulin G, and IgG4 immunoglobulin. A Quantiferon Gold test was sent three times before receiving a report that it was positive after all the above evaluation and the diagnostic procedure were complete. A diagnostic procedure was done
Date
2015
Language
eng
Format
video/mp4
Type
Image/MovingImage
Relation is Part of
NANOS Annual Meeting Frank B. Walsh Sessions; 2015
