A Difficult Day with Double Trouble (.pdf)

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Identifier 20160228_nanos_posters_093
Title A Difficult Day with Double Trouble (.pdf)
Creator Nailyn Rasool, Ilya Leskov, Mary Beth Cunnane, John H Stone, Anna Stagner, Joseph F. Rizzo, Vikram Deshpande, Dean M Cestari
Subject hypertrophic pachymeningitis, IgG4, lupus
Description "A 59 year old woman with a history of hypothyroidism, an inner ear implant and lupus (complicated by autoimmune hemolytic anemia and raynaud's disease) presented with 1 week of intermittent horizontal binocular diplopia. She denied headache and giant cell arteritis symptomatology. Examination demonstrated normal afferent function, full ductions and an incomitant esotropia worse in right gaze. She was diagnosed with a subtle microvascular right sixth nerve palsy. Two weeks later, she developed intractable bifrontal headaches and photosensitivity. On neuro-ophthalmic evaluation she had bilateral limitation of abduction, left greater than right, and slight limitation of elevation of both eyes. A head CT with enhancement demonstrated slightly enlarged extraocular muscles and crowding of the orbital apex bilaterally. Bloodwork was significant for a slightly elevated WBC count with a longstanding microcytic anemia (Hb 10.4) and thrombocytosis. Thyroid function studies and myasthenia gravis work-up was normal. However, antithyroglobulin antibody was elevated at 59 (N<2). Thyroid orbitopathy was considered a probable diagnosis at this time. However, the patient's complaint of relentless headaches prompted persuing an MRI brain and orbits with contrast that demonstrated diffuse pachymeningeal enhancement, abnormal enhancing soft tissues in the orbital apices bilaterally particularly surrounding the intercanalicular segments of the optic nerves and enlarged enhancing extraocular muscles. Lumbar puncture demonstrated an opening pressure of 24 cm H20 with normal constituents. Blood ACE, lysozyme, RPR, VDRL, ANCAs, complement level and inflammatory markers were unremarkable. The patient improved significantly upon solumedrol although diagnosis was unclear. An immunoglobulin and IgG4 level was ordered and the serum IgG4 level was significantly elevated."
Relation is Part of NANOS Annual Meeting 2016: Poster Presentations
Contributor Primary Nailyn Rasool, Ilya Leskov, Mary Beth Cunnane, John H Stone, Anna Stagner, Joseph F. Rizzo, Vikram Deshpande, Dean M Cestari
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2016-02-28
Type Text
Format application/pdf
Format Creation application.pdf
Source 2016 North American Neuro-Ophthalmology Society Annual Meeting
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6ff7088
Setname ehsl_novel_nam
Date Created 2016-07-21
Date Modified 2016-10-11
ID 185134
Reference URL https://collections.lib.utah.edu/ark:/87278/s6ff7088
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