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Hard to Get

Hard to Get. R. Huna-Baron MD (1) Sheba Medical Center. History. 77 year old male Right eye visual loss Severe right headache. Past medical history. Hypertension Ischemic heart disease Basal cell carcinoma Invasive transitional cell carcinoma (TCC) - cystectomy and chemotherapy.

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Hard to Get

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  1. Hard to Get R. Huna-Baron MD (1) Sheba Medical Center

  2. History • 77 year old male • Right eye visual loss • Severe right headache

  3. Past medical history • Hypertension • Ischemic heart disease • Basal cell carcinoma • Invasive transitional cell carcinoma (TCC) - cystectomyand chemotherapy

  4. History • Three months prior right severe headache – diagnosed as trigeminal neuralgia by a neurologist • Two months prior right eye visual blur

  5. Work up done before • CBC - wnl • ESR - 17mm/hr • SMAC - wnl • MRI – read as “only ischemic white matter changes and normal optic nerves” • CT of chest and abdomen - no change • Temporal artery biopsy - negative

  6. Examination • Visual acuity – OD-finger counting OS-6//7.5 • Color vision- Ishihara color plates OD - none, OS - 14/14 • Trigeminal & facial functions - intact • Ocular movements - mild limitation of elevation • Pupils - OD +3 APD

  7. Examination – cont. • Dilated fundus exam: OD - mild pale swelling, no cells in the vitreous OS - normal

  8. Examination- cont. • Humphrey (24-2) : OD - dense temporal, superior defect OS - mild superior constriction

  9. Examination - cont. • Slit-lamp - bilateral 3+ nuclear sclerosis cataracts • The remainder of the general and neurological exams was normal

  10. How you define patient’s condition? • What is your differential diagnosis? • How are you going to proceed?

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