An 81-year-old woman presents with a one-month history of blurred vision OS, acutely worse in the past 5 days. She reports pain with left gaze, left sided forehead tenderness and some weight loss. Medical history includes hypertension, borderline diabetes, cerebral vascular accident and basal cell carcinoma of the face. Her medications include rivaroxaban, metoprolol, atorvastatin and omeprazole. Visual acuity is 20/20 OD and light perception OS. Color vision is 11/11 OD and 0/11 OS. Confrontational fields are full in the right eye and non-recordable in the left eye. Pupils are reactive and equal OU, with a greater than 1.2 log unit APD OS. Anterior segment exam reveals bilateral intraocular lenses. Dilated exam: OD is unremarkable, and OS is noted to have pallid disc edema with several hemorrhages. Initial blood work reveals an ESR 36mm/hr and CRP 5.4 mg/L (normal <3.0). MRI head obtained at outside facility showed abnormal enhancement along the orbital portion of the left optic nerve. Prednisone 60mg/day is initiated for presumed GCA and temporal artery biopsy scheduled. Contact is also made with the patient's primary care physician to stop rivaroxaban. A left temporal artery biopsy showed calcific atherosclerosis, without evidence of active or treated arteritis. Vision in left eye progressed to no light perception. Dedicated orbital MRI study with and without gadolinium showed mild enlargement and enhancement of the left optic nerve, possibly worse than prior. Patient admitted to hospital for workup. CT Chest - no evidence of sarcoidosis. LP - glucose 113 (serum 276), protein 31, WBC <1, cytology negative for malignant cells. Repeat dilated exam showed increased vitreous cells and debris in the left eye. A procedure was performed…
Date
2015
Language
eng
Format
video/mp4
Type
Image/MovingImage
Relation is Part of
NANOS Annual Meeting Frank B. Walsh Sessions; 2015
