Requiem for a Cabinet Maker

Update Item Information
Identifier walsh_2015_s2_c1
Title Requiem for a Cabinet Maker
Creator Jennifer I. Doyle, Michael S. Vaphiades, MD, University of Alabama, James R. Hackney, Lanning B. Kline, Lina Nagia
Subject Transient Monocular Visual Loss, Orbital Tumor, Facial Numbness, MRI, Pathology special staining
History A 54-year-old white male presents with 3 weeks of painless horizontal nystagmus and 6 months of left sided forehead numbness. He reports a 20 lbs weight loss. Medical history includes a renal transplant 30 years prior. He takes prednisone 30 mg QOD and azathioprine. Visual acuity is 20/20 OU, color vision is 8 of 8 OU and confrontational fields are full OU. Pupils are equal and reactive without an R APD. Ductions are full but with end gaze nystagmus. There is no proptosis or ptosis but there is decreased V1 sensation on the left. Fundus examination is normal. A contrasted cranial and orbital MRI showed an enhancing mass in left superior orbit. He was treated with a Medrol dose pack and had mild improvement in symptoms. Left orbital biopsy was read as orbital fibrotic histiocytoma. One month later his examination showed NLP vision OS associated with an amaurotic pupil. He had decreased abduction OS. He had 4 mm of proptosis OS. Left V1 sensation was still diminished and fundus remained normal OU. He was admitted to the hospital and prescribed IV methylprednisone. Repeat MRI showed increased in size of left orbital mass, now involving the optic nerve. CT orbits showed adjacent bone demineralization. He underwent left orbital radiation. Five months later, patient presents to ED with shortness of breath and transient visual loss OD. Vision remained 20/20 OD and NLP OS. Ductions now show limited superior gaze OD and limited all directions OS. Decreased left sided V1 and V2. No optic disc edema OD and mild optic nerve edema OS. MRI shows enlarging left sided orbital mass with a new right-sided retro-orbital mass. Further work up reveals new bilateral pulmonary nodules and metastatic appearing hepatic lesion. A diagnostic procedure was performed.
Format application/pdf
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
ARK ark:/87278/s61c4tgb
Contributor Primary Jennifer I. Doyle; Michael S. Vaphiades; James R. Hackney; Lanning B. Kline; Lina Nagia
Setname ehsl_novel_fbw
ID 179267
Reference URL https://collections.lib.utah.edu/ark:/87278/s61c4tgb