Академический Документы
Профессиональный Документы
Культура Документы
with
4 week history of left eye blurriness
Headache x 1 month,
- Sent to OSH ER
Differentials????
PMHHypertension
Diabetes mellitus
Heart abnormality
Hepatitis C
PSHTonsillectomy
Lap cholecystectomy
Fractured tibia
Medications
Aspirin
Tramadol
Losartan
Amlodipine
Metformin
Glipizide
Zofran
Review of Systems:
General: weight loss, fatigue, weakness
HEENT: Denies rashes, itching, headache, acute visual changes, hearing loss,
tinnitus, rhinorrhea, hoarseness, sore throat
Cardiac: Denies chest pain, palpitations, dyspnea on exertion, edema
Respiratory: Denies shortness of breath, wheezing, sputum, hemoptysis
Gastrointestinal: Denies abdominal pain, nausea, vomiting, change in bowel habits,
diarrhea, constipation, hematochezia, or melena
Genitourinary: Denies dysuria, hematuria hesitancy, frequency
Musculoskeletal: Denies muscle weakness, joint pain or stiffness
Neurologic: Denies numbness or tingling in extremities, dizziness, lightheadedness
Hematologic: Denies easy bruising/bleeding
Endocrine: Denies thyroid problems, diabetes
Physical Exam
VITALS:
BP 147/65
Pulse 76
Temp 97.6 F (36.4 C)
Resp 18 BMI 25.60 kg/m2 | SpO2 97%
Neuro exam
Cranial Nerves:
Pupils-right 4mm reactive to light, left-8mm non reactive to light; Complete ptosis of left eye,
EOM- right-intact except some limitation of right lateral movement (LR muscle), left eye- EOM impaired in all
directions
Facial sensation intact bilaterally to light touch but complains about tingling bilaterally in V1 distribution; no facial
palsy
Hearing intact to finger rub bilaterally
Palate symmetric; normal tongue protrusion
Shoulder shrug symmetric
Motor:
Abnormal Movements: None
Bulk: Atrophy of interossei muscles of hands, also tibialis anterior muscle atrophy
Tone: Normal
Strength: RUE 5/5, LUE 5/5, RLE 5/5, LLE 5/5
DTR: Bi Tri BR Pat Ach Toes
R 2 1 2 2+ 1 Down
L 2 1 2 2+ 1 Down
Hammer toes and high arched feet (pes cavus) noted
Sensory:
Intact to light touch bilaterally
Cerebellar:
FNF intact bilaterally
Gait:
Normal stride and stance, but difficult to do tandem walk, toe walking and single leg standing not possible
Ophthal Exam
DIFFERENTIALS??????
Labs BMP:
NA 127 L
K 3..9
CL
94 L
CO2 25
BUN 23
CREA
0.8
GLU 177 H
CBCWBC
9.6
HGB 13.3
Neutro 68%
Lymho 22%
HCT 35.2
PLT 136 L
UDS positive for
opiates
Hepatic Function
Total Protein
Albumin
Tbil
ALP
ALT
AST
5.0
2.6
0.6
89
45
38
Total Protein
Albumin
Alpha-1 Globulins
Alpha-2 Globulins
Beta Globulins
Gamma Globulins
CT Head
CT ORBIT
MRI BRAIN
MRI BRAIN-
MRI ORBIT
MRI Head
Acute left sphenoid sinusitis superimposed upon chronic
sinusitis causing dehiscence or erosion of the anterior
and lateral walls of the left sphenoid sinus including the
medial wall of the left supraorbital fissure with extension
of disease into the left orbital apex.
Hospital Course Continued Mass was removed and sent for micro and
pathology.
Micro revealed segmented hyphae.
ID was consulted , Amphotericin B and decadron
started.
Vision acutely worsened and now pt reported
complete loss of vision in R eye as well .
Neurosurgery consulted for further assistance in
treatment
Scedosporium
found ubiquitously in the environment,
including in soil and polluted water.
Two most common ones are
- Scedosporium apiospermum
- Scedosporium prolificans
Human infection = from inhalation of
spores or through direct inoculation, as in
a skin puncture
Scedosporium-
Microscopy-
- eye pain,
photophobia, foreign body sensation, conjunctival or corneal
erythema, tearing, and changes in visual acuity.
Scedosporium corneal infections can lead to frank corneal
ulceration, abrasion, perforation, infiltrate, and anterior chamber
hypopion
Diagnosis
Histopathology
Cultures
Molecular techniques
Antigen detection
Treatment