Case Presentation On

8/3/2019 Case Presentation On

http://slidepdf.com/reader/full/case-presentation-on 1/30

AMIT TYAGI

28 YRS / MALE

147486 DOA- 19-05-08

DOD- 25-05-08

R/O VINOD NAGAR



C/O Sudden painless diminution ofvision in the LE since 2 days

HOPI:Patient was apparently well 2 days back

then he noticed sudden painless

diminution of vision in LE.

No h/o trauma

No h/o floaters

No h/o photopsia,sudden appearanceof dark clouds in front of the eye



No h/o localised relative loss in field ofvision

h/o dyschromatopsia,decreasedbrightness of the objects

No h/o flashes of light/sparkles onhearing loud sounds or moving or closing the eyes

No h/o micropsia/metamorphopsia

h/o slight discomfort around the eye

No h/otingling/paraesthesia/weakness of thelimbs



No h/o worsening of the symptoms onexposure to heat/on exercise

No h/o unsteady gait,dysarthria

No h/o fever/rash

No h/o frontal headache or any

symptoms suggestive of sinusitis

No h/o tick bite

No h/o joint pains/myalgia

No h/o cat scratch/bite

No h/o genital ulceration



No h/o lymphadenopathy

No h/o cough

No h/o recent immunisation

No no tremors/palpitations

No h/o exposure to toxic fumes

No h/o intake of cheap adulteratedbeverage

H/o single episode of vomitingassociated with headache 5 daysback

No h/o seizures or loss of consciousness



Pt. consulted an ophthalmologist inghaziabad where he was diagnosed

a case of optic neuritis(by papers) His vision was RE-6/6 LE-6/9

He was referred to a higher centre

No h/o any complaints in the RE

PAST HISTORY:

No h/o similar complaints in the past

No h/o HT/TB/DM



PERSONAL HISTORY:

vegetarian ,non smoker,non alcoholic

FAMILY HISTORY:

No h/o such complaints in the family



Pt. is conscious,cooperative,well

oriented wgt -58 kg P-82/min RS-NAD

RR-16/min CVS-NAD

BP-130/80 mm Hg No pallor,cyanosis,icterus,clubbing

No neck stiffness,no sensory/motor

deficit No sinus tenderness,No cerebellar

signs

No lympadenopathy,scalp tenderness



RE LEVISION 6/6

PR Accurate6/6PR Accurate

Headposture

maintained

Facial

symmetry

symmetrical

Hirschberg’s central



Cover uncover test orthophoria

Ocular movements slight painpresent in upgazein LEfull in all gazes

Orbit N N

Eyeball N

No globetenderness

N

No globetenderness

Eyebrows N N



Eyelids N N

Lacrimalapparatus

N N

Conjunctiva N N

Sclera N N

Cornea clear,sensations intact

clear,sensations intact



Anterior chamber

-depth-contents

NClear

NClear

Iris

-colour -pattern-neovasc

brownN

absent

brownN

absent



Pupil-size

-shape-position-reactions

3-4 mm

roundcentralD+C+

3-4 mm

roundcentral

Direct reflex issluggish,ill-sustained,consensual is more ascompared to RE

RAPD +



Lens N N

Vitreous no cells seen no cells seen

DDO

(24-05-08)



Direct &indirect

ophthalmoscopy

Disc nasalmargins ill

definedHyperemia +Vessels normalNo

haemoragesVenouspulsations

absentNo retinaledema

FR +

Disc margins ill-defined

Hyperemia +Vessels tortuousPara papillaryhaemorage+

(nasally)No venouspulsations

Retinal edema+Retinal folds +Nasally

FR distorted



RE



LE



Fundusexamn with

90D lens(24-05-08)

Disc slightlyhyperemic

Nasalmargins illdefinedNo discelevationNo retinaledema

Vesselsnormal

Disc headelevation

seen(about 1mm as seenon directophthalmoscope)Venousbeading+

VesselstortuousRetinal

edema+



Hb-12.8 % Na-139

TLC-7800 X 10*3 K-5.1

DLC-N65 L32 E02 B01 RBS-112

Bld urea-28 ESR-15 mm Sr creat-0.8 VDRL-non reactive

T.Bil-1.6 AR- RE= -0.75/-0.75 AT 20

ALT-12 LE= -0.50 AT 5 AST-24 NCT= RE 17.3

ALP-84 LE 17.3



Brightness-Pt. appreciates light lessbrighter in the LEColour vision-(ISHIHARA)

RE-WNLLE-Pt was not able to see letters

Chest x-ray-WNL

X-ray orbit (BE)-(AP & LATERAL)-WNL

ECG-WNL





Patient was not able to appreciatethe green target



RE

Posterior segment

anechoiecno optic disc

head elevation

seen

LE

Posterior segment

anechoiecOptic disc head

elevation seen

(1 mm)



LE



RE



DONE ON 29-05-08

REPORT AWAITED



LE -IDIOPATHIC OPTIC NEURITIS

RE-EARLY PAPILLITIS



IV Methyl prednisolone 1 gm qid individed doses x 3 days

Followed by oral prednisolone 1

gm/kg/day x 11 days To be tapered for 3 days

Tab Rantac 150 mg bd

Tab neurokind 1 odCap Amoxycillin 500 mg tds



VA-RE 6/6

LE 6/9

OCULAR PAIN STILL +nt ON UPGAZE

PUPILS-RE D+C+LE D+C+ RAPD DECREASED

COLOUR VISION RE-WNL

LE-Pt, not able to readonly a few green letters



RE-Same status

LE-Edema slightly reduced

rest status same

ON FURTHER FOLLOW UPS: VA-6/6 BE

RAPD DISAPPEARED ON 24-05-08

REST ALL FINDINGS SAME

Documents

Case Presentation On