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226 A Prolonged Path To The Final Diagnosis (abstract)Cindy Lam; Edward MarglinPreviously healthy 25-year-old male presented with a 3-week history of frontal headache, right 3rd nerve palsy with ptosis, and areflexia of the left leg. MRI brain was normal. Two days later new symptoms developed: lower back pain, paresthesias, left leg weakness, right facial weakness.
227 A Prolonged Path To The Final Diagnosis (video)Cindy Lam; Edward MarglinPreviously healthy 25-year-old male presented with a 3-week history of frontal headache, right 3rd nerve palsy with ptosis, and areflexia of the left leg. MRI brain was normal. Two days later new symptoms developed: lower back pain, paresthesias, left leg weakness, right facial weakness.
228 Not Surprised Surprise (abstract)Yu Zhao; Joshua Pasol; Sander Dubovy; Byron LamA 68-year-old Hispanic woman presented to our emergency department with significant vision loss OS for 1 week. A month ago, she was evaluated locally for mild blurry vision OS, and corrected acuity was 20/30 OD, 20/40 OS. She was diagnosed with cataracts and epiretinal membrane OD. Medical history i...
229 Strike a Chord (abstract)Anastasia Neufeld; Kathleen Digre; Cheryl Palmer; H. Christian Davidson; Alison Crum; Bradley Katz; Judith WarnerA 26 year old woman presented in August 2016 with migraine over the last 4 years, getting worse over the last 2 weeks. She reported occasional 'glittering' in her vision in both eyes. She had no constitutional symptoms. Her past medical history included migraine, idiopathic leukocytosis, and nephrol...
230 The Sound of Hoofbeats (abstract)Lilangi Ediriwickrema; Neil Miller; Thomas BosleyA 42-year-old woman with a recurrent cerebral malignant glioma in the left frontal lobe on clinical trial presented with blurry vision in her right eye 6 days after undergoing sinus surgery for paranasal inflammatory changes. She presented approximately 1 month after the sixth cycle of systemic ster...
231 Strike a Chord (slideshow)Anastasia Neufeld; Kathleen Digre; Cheryl Palmer; H. Christian Davidson; Alison Crum; Bradley Katz; Judith WarnerA 26 year old woman presented in August 2016 with migraine over the last 4 years, getting worse over the last 2 weeks. She reported occasional 'glittering' in her vision in both eyes. She had no constitutional symptoms. Her past medical history included migraine, idiopathic leukocytosis, and nephrol...
232 A Wrong Turn at the Angle (slideshow)Erica Archer; Jonathan Trobe; Hemant Parmar; Mohannad Ibrahim; Paul McKeever; Thomas GiordanoA 54-year-old woman developed numbness of the right jaw and right side of the tongue. She attributed her symptomatology to recent dental work, but when dental examination, including dental x-rays, failed to reveal an answer, she underwent brain MRI.
233 A Wrong Turn at the Angle (video)Erica Archer; Jonathan Trobe; Hemant Parmar; Mohannad Ibrahim; Paul McKeever; Thomas GiordanoA 54-year-old woman developed numbness of the right jaw and right side of the tongue. She attributed her symptomatology to recent dental work, but when dental examination, including dental x-rays, failed to reveal an answer, she underwent brain MRI.
234 Alcohol is Never the Answer, but it Does Make You Forget the Question (slideshow)Ali Saber Tehrani; Diana Londono; Thomas Rashid; Manuel Doria; Julia Biernot; Jorge KattahA 63-year old male with a history of alcohol abuse presented with two weeks of confusion and imbalance. On exam, he had left beating nystagmus on left gaze, and right beating and torsional nystagmus on right gaze. Head impulse test was abnormal in all canals bilaterally with video head impulse test ...
235 Nonchalant Midterm-taker Develops Altered Mental Status (slideshow)Shira Simon; Bruno Policeni; Matthew ThurtellA 19 year-old female presented in April 2016 with two weeks of worsening headaches, malaise, left-hand weakness, and confusion. Symptoms started during a trip to Cancun and one week after visiting a friend with mumps. Although she was becoming increasingly lethargic, she refused to seek medical atte...
236 Nonchalant Midterm-taker Develops Altered Mental Status (video)Shira Simon; Bruno Policeni; Matthew ThurtellA 19 year-old female presented in April 2016 with two weeks of worsening headaches, malaise, left-hand weakness, and confusion. Symptoms started during a trip to Cancun and one week after visiting a friend with mumps. Although she was becoming increasingly lethargic, she refused to seek medical atte...
237 Pseudo-Pseudotumor Cerebri (video)Valerie Biousse; Jose Velázquez Vega; Amit Saindane; Nancy NewmanA 54-yo man presented with a 10-month history of daily headaches and bilateral disc edema. PMHx was remarkable for uncomplicated type-2 diabetes mellitus, and hypothyroidism. He developed headaches in 07/2014 after being stung by wasps.
238 A Diagnostic Potpourri (video)Padmaja Sudhakar; Robert Lightfoot; Douglas Lukins; Dianne WilsonA 63 yr. old incarcerated man with history of diabetes, hypertension, rheumatoid arthritis (RA) (on hydroxychloroquine, sulfasalazine and prednisone 7 mg), cutaneous lupus and Hepatitis C presented with sudden painless vision loss of the left eye without headache or symptoms of temporal arteritis. V...
239 Keep Your Eye On the Ball (video)Danielle Rudich; Eugenia Vining; Kenneth Allen; Joel Geffin; Mena Mansour; Robert LesserIn March 2014, an 82-year-old male developed left sided facial pain and numbness over his left temple and periorbital region. He was treated for a presumed dental infection with no response. MRI brain in July 2014; showed only microvascular white matter changes.
240 Island Fever (slideshow)Laura Hanson; Judith Warner; Alison Crum; Bradley Katz; Kathleen DigreA 22 year-old male paralegal in the military presented with double and blurred vision. One month ago, he had traveled to Hawai'i for a wedding. Two weeks ago, he had been evaluated for an acute onset of fever, headache, emesis, light sensitivity and neck stiffness.
241 It Must Be Voodoo... and he was Far from Spineless (abstract)Norah Sydney Lincoff; Charles Chung; Lucia BalosA 35 yo legally blind gentleman was referred for evaluation because of neck and new lower back pain. His visual; loss began 4 years prior, following a trip to 'N'Orleans'. He had been on a 'Boys Trip' for 10 days, and had been cursed with Voodoo for not paying a cemetery tour guide as promised.
242 Pseudo-Pseudotumor Cerebri (slideshow)Valerie Biousse; Jose Velázquez Vega; Amit Saindane; Nancy NewmanA 54-yo man presented with a 10-month history of daily headaches and bilateral disc edema. PMHx was remarkable for uncomplicated type-2 diabetes mellitus, and hypothyroidism. He developed headaches in 07/2014 after being stung by wasps.
243 Papilledema Gone Wrong (abstract)Ahmara Ross; Payal Patel; Jessica Panzer; Grant LiuA 12 year old obese female with a history of enterovirus meningitis presented with throbbing, constant, 10/10, occipital and positional headaches, associated with diplopia, photophobia, nausea, and vomiting for one week in; the setting of a recent 20 lb. weight gain. Her vision, pupils, fields, and ...
244 Occam Rings True (video)Reid Longmuir; Michael Bradshaw; Taylor Davis; Woon Chow; Laura Craig-Owens; Kim Ely; Katherine McDonellA 57-year-old, previously healthy man was referred for vision loss in both eyes. Six weeks before our evaluation, he presented to an outside ophthalmologist with 'greying' of the central vision in his right eye that progressed to blindness over a week.
245 M.I.A. (video)Julie DeBacker; Janet Rucker; Josef Gutman; Heather Lau; Laura Balcer; Steven GalettaA 69-year-old man presented with a several year history of vertical double vision. At age 46, he presented with a two year history of imbalance, four year history of urinary urgency/frequency, and a six-month history of leg numbness and tingling.
246 A 'Frosty' Altered Level of Consciousness (slideshow)Alaa Bou Ghannam; Emily McCourt; Victoria Pelak; Jeffrey Bennett; Prem Subramanian; David Smits15-year-old previously healthy male, transferred because of 9-day history of headache, difficulty walking, diplopia, blurry vision and new onset altered level of consciousness. Neurologic examination was remarkable for delirium; with semi-coherent speech, VA of CF 2ft and 20/400, no APD, and bilater...
247 A 'Frosty' Altered Level of Consciousness (video)Alaa Bou Ghannam; Emily McCourt; Victoria Pelak; Jeffrey Bennett; Prem Subramanian; David Smits15-year-old previously healthy male, transferred because of 9-day history of headache, difficulty walking, diplopia, blurry vision and new onset altered level of consciousness. Neurologic examination was remarkable for delirium; with semi-coherent speech, VA of CF 2ft and 20/400, no APD, and bilater...
248 Keep Your Eye On the Ball (slideshow)Danielle Rudich; Eugenia Vining; Kenneth Allen; Joel Geffin; Mena Mansour; Robert LesserIn March 2014, an 82-year-old male developed left sided facial pain and numbness over his left temple and periorbital region. He was treated for a presumed dental infection with no response. MRI brain in July 2014; showed only microvascular white matter changes.
249 Looking for a Drop of Porcelain - VideoShannon J. Beres; Grant T. LiuA 4 year old healthy boy presented with severe headache. A right subdural hygroma was seen on brain MRI and CSF evaluation showed a leukocytosis with elevated protein. A week later he developed left leg weakness and a repeat brain MRI showed progressive leptomeningeal enhancement and new punctate in...
250 Heart of Darkness - VideoShira Simon; Shiraaz I. Rahman; John C. Heymann; Bahram Rahmani; Nicholas J. VolpeAn 18 year-old woman presented to the emergency department in October 2014 with three days of blurred vision in her left eye. Past medical history included a hypoplastic right heart status-post orthotopic heart transplant at 2 months of age, chronic kidney disease with BK viremia since 12 years of a...
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