Diagnostic Challenge: The Case of a 70-Year-Old Man Who Presents With Progressive Vision Loss and Headaches

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Malya Sahu, Rohini Samudralwar
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引用次数: 0

Abstract

A 70-year-old presents with 6 weeks of progressive bilateral vision loss and headaches. He was also recently treated for presumed sciatica. His exam on admission is notable for poor visual acuity (no light perception), optic nerve atrophy bilaterally with swelling and disc hemorrhage on the left eye and left foot drop. MRI orbits reveals diffusion restriction and enhancement of bilateral optic nerves extending into the optic chiasm. He undergoes bilateral temporal artery biopsy due to concern for giant cell arteritis and high-dose steroids with no improvement in vision and both biopsies are normal. Ultimately, full neuro-axis imaging reveals evidence of leptomeningeal enhancement of the cerebellum, cervical and thoracic spine, and cauda equina nerve roots, as well as bilateral posterior semicircular canal enhancement and developing hydrocephalus. A CNS diagnosis is made via lumbar puncture, though ultimately the patient eventually expires in the hospital.

Abstract Image

Abstract Image

诊断挑战:一个70岁的男人谁表现为进行性视力丧失和头痛的情况。
一位70岁的老人出现6周的进行性双侧视力丧失和头痛。他最近还接受了假定坐骨神经痛的治疗。入院检查:视力差(无光感),双侧视神经萎缩,左眼肿胀、盘状出血,左脚下垂。MRI轨道显示双侧视神经扩散受限和增强,延伸到视交叉。由于担心巨细胞动脉炎和大剂量类固醇,他接受了双侧颞动脉活检,视力没有改善,两次活检均正常。最终,全神经轴成像显示小脑、颈椎、胸椎和马尾神经根的脑脊膜增强,以及双侧后半规管增强和脑积水。中枢神经系统的诊断是通过腰椎穿刺,但最终患者在医院去世。
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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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