| Identifier |
walsh_2015_s2_c2-2 |
| Title |
Three Weeks in Florida |
| Creator |
Andrew R. Carey |
| Subject |
Papilledema; Leptomeningeal Melanomatosis; Vision Loss; Headache; Magnetic Resonance Imaging |
| History |
A 36 year-old man presented with severe headaches, bilateral leg numbness, and bilateral decreasedvision. He was born in Ecuador where he received BCG vaccination and immigrated to US at age 19. In2005 he enrolled in nursing school and volunteered in homeless shelters. PPD was positive with anegative chest x-ray. In August 2011 he developed pleuritic chest pain; chest x-ray showed a 2 cmcavitary lesion in the right upper lobe. He was diagnosed with active TB and completed treatment inAugust 2013. In December 2013 he developed headaches associated with neck stiffness and intermittentblurry vision which progressed over 6 months. In May 2014, while on vacation in Ecuador, he had aprolonged seizure requiring intubation. Upon recovery he returned to Florida and presented to theemergency department with visual loss and drowsiness, but arousable to verbal stimuli. Vision was lightperception OU with sluggish pupils. Extraocular movements were full but demonstrated exotropia.Fundus examination showed papilledema. Strength was reduced in all four limbs with apraxia in theupper right. Sensation was decreased from groin to foot, left worse than right. Serum white count waselevated to 25,300. Brain MRI demonstrated hydrocephalus and diffuse leptomeningeal enhancementincluding bilateral intracranial optic nerves and chiasm. CSF analysis showed 110 leukocytes with 66%monocytes. Lumbar spine MRI was negative. The patient was diagnosed with recurrent TB withmeningitis and was restarted on TB medications. CSF smears, cultures, and PCR were negative forinfection including TB. Lumbar drain was placed and ICP was 40 cm water. Repeat brain MRI showedprogressive leptomeningeal enhancement and hydrocephalus. Repeat CSF analysis demonstrated cellularatypia with equivocal immuno-histochemical staining. Flow cytometry revealed a mixture of immunecells but no B lymphocytes. A diagnostic procedure was performed. |
| Date |
2015-02-22 |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| Source |
2015 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2015 |
| Collection |
Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416 |
| Rights Management |
Copyright 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6j70dhk |
| Contributor Primary |
Lynn K. Gordon |
| Contributor Secondary |
Guy V. Jirawuthiworavong |
| Setname |
ehsl_novel_fbw |
| ID |
179294 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6j70dhk |
