Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Paediatric Ophthalmology
Case 2
Patient Presentation: An 8-year-old asymptomatic male patient was referred by an optometrist for an atypical optic nerve OD. The patient denied visual field deficits, flashes or floaters. Visual acuity was 20/20 OU; IOP was WNL.
OCT RNFL and macula imaging was conducted and is shown below:
Question 1: What is the best description of the OCT macula?
The fundus findings are shown below:
Question 2: Based on the fundus photograph and OCT imaging, what is the most likely diagnosis?
Question 3: What is the urgent next step for this patient?
Question 4: What type of disease is this?
References:
Chowaniec MJ, Suh DW, Boldt HC, Stasheff SF, Beer PM, Barry GP. Anomalous optical coherence tomography findings in Wyburn-Mason syndrome and isolated retinal arteriovenous malformation. J AAPOS. 2015 Apr;19(2):175-7. Doi: 10.1016/j.jaapos.2014.09.019. Epub 2015 Mar 28. PMID: 25828823.
Dayani PN, Sadun AA. A case report of Wyburn-Mason syndrome and review of the literature. Neuroradiology. 2007 May;49(5):445-56. Doi: 10.1007/s00234-006-0205-x. Epub 2007 Jan 18. PMID: 17235577.
Ravani R, Patel C, Tripathy K. Optical coherence tomography of racemose angioma. Clin Case Rep. 2020 Apr 12;8(7):1299-1300. Doi: 10.1002/ccr3.2841. PMID: 32695379; PMCID: PMC7364105.
So JM, Mishra C, Holman RE. Wyburn-Mason Syndrome. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www-ncbi-nlm-nih-gov.ezproxy.library.ubc.ca/books/NBK493218/
Learning Objectives:
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Recognize the presentation and differential diagnoses of neurocutaneous disorders.
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Identify the urgent investigations for Wyburn-Mason Syndrome.