| Identifier |
walsh_2022_s3_c1 |
| Title |
The Inconspicuous Cysts |
| Creator |
Lily Zhang, Folusakin Ayoade, Julio Diaz Perez |
| Subject |
papilledema, magnetic resonance imaging (MRI), vision field loss, ring-enhancing lesions, lumbar puncture |
| History |
A previously healthy 40-year-old male, with a past medical history significant for latent tuberculosis s/p treatment 15 years; ago, presented with blurry vision and progressively worsening headaches for 6 months. He was originally from Guatemala; and moved to the US in 2001 (crossed the deserts through Mexico and Texas). On exam, his visual acuity was 20/20 OU; with dense peripheral field loss and bilateral grade 5 papilledema with hemorrhages. MRI brain/orbits showed bilateral; flattening of the posterior sclera with intraocular protrusion of the optic nerve head and prominent leptomeningeal; enhancement. The patient was admitted to a multidisciplinary team and an extensive workup was performed. His lumbar; puncture (LP) showed an elevated opening pressure (OP >40 CmH2O), severe hypoglycorrhachia, high protein, borderline; elevated CSF eosinophils and lymphocytic pleocytosis. His extended CSF/serum/imaging studies were unrevealing. Given; the chronicity of the symptoms, epidemiologic factors (history of having crossed the deserts through Mexico and Texas) and; CSF findings, he was considered most likely to have chronic fungal meningitis (Coccidiodes). Empiric antifungal treatment; was started. A month later, the patient returned with decreased visual acuity of 20/40 OD, worsening visual fields, and; papilledema. He was put on acetazolamide and readmitted. Repeated brain MRI revealed similar pachymeningitis. Thoracic; MRI showed mildly enhanced mid-right anterolateral cord lesion and pial linings around mid-distal cord and conus.; Repeated LP showed elevated OP and CSF signs of meningitis, but his extended CSF/serum studies remained unrevealing.; Due to his high risk of vision loss, a VP shunt was placed and antifungal treatment was continued. He returned 2 months; later with abdominal pain, urinary retention, and difficulty in ambulating. MRI spine showed diffuse leptomeningeal; enhancement that had worsened collections, rim enhancing lesions, and cord compression. A diagnostic procedure was; performed. |
| Disease/Diagnosis |
Severe extra-parenchymal neurocysticercosis (NCC) with arachnoiditis and spinal lesions resulting in papilledema, lowerSevere extra-parenchymal neurocysticercosis (NCC) with arachnoiditis and spinal lesions resulting in papilledema, lower; extremity weakness, and bladder dysfunction |
| Date |
2022-02 |
| References |
1. Carrillo Mezo, R., et al., Relevance of 3D MRI sequences in diagnosing basal subarachnoid neurocysticercosis, Acta; Trop, 152, 60-5, 2015.; 2. Arroyo, G., et al., Antibody Banding Patterns of the Enzyme-Linked Immunoelectrotransfer Blot and Brain Imaging; Findings in Patients With Neurocysticercosis. Clin Infect Dis, 66, 282-88, 2018.; 3. O'Connell, E.M., et al., A Novel, Highly Sensitive Quantitative Polymerase Chain Reaction Assay for the Diagnosis of; Subarachnoid and Ventricular Neurocysticercosis and for Assessing Responses to Treatment, Clin Infect Dis, 70(9), 875-; 1881, 2020.; 4. White, A.C., Jr., et al., Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious; Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH),Am J Trop Med; Hyg, 98(4), 945-66, 2018.; 5. Qi, B., et al., Spinal intramedullary cysticercosis: a case report and literature review, Int J Med Sci, 8(5), 420-3, 2011. |
| Format |
application/pdf |
| Type |
Text |
| Source |
54th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting 2022: Walsh Session III |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2022. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6k3s901 |
| Contributor Primary |
Lily Zhang, MD |
| Contributor Secondary |
Folusakin Ayoade, Julio Diaz Perez |
| Setname |
ehsl_novel_fbw |
| ID |
2100239 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6k3s901 |
