NANOSNET

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od 

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od 

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od 

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od 

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od 

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od 

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od 

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od 

I inherited a patient this year and was prev seen by a now retired neuro-ophthalmologist.

59yo male with pauci symptomatic right optic disc swelling cause nyd 

Background: Chronic kidney disease, HTN, dyslipidemia, umbilical hernia, kidney stones 2021 req ureteric stent now removed.  

Medications: perindopril 10mg daily, atorvastatin 20mg daily. 

2016 found to have right optic disc swelling on routine opt. He has metamorphopsia centrally od. Normal os.  

Exam: 88kg  BMI 26 

VA 6/9.6cc PH 6/7.5 od 6/6cc os CP 7/7 ou, pupils 3mm ou in light 4mm ou in dark. Small right RAPD. Fundoscopy: grade 2 disc swelling od normal os. Full eye movements, orthophoric in all gaze positions. 

HVF: 30-2:  enlarged blind spot od normal os 

Autoflorescence –ve for drusen 

9Feb2017: LP opening pressure 21cmCSF. <1 leucocytes, <1 erythrocytes protein 0.48, glucose 3.3 no organisms, no malignant cells 

14May18 LP opening pressure 20cmCSF: leucocytes 4 rbc 1 protein 0.44 glucose 3.1. Cytology negative 

MRI brain and orbits x 5 normal. 2017 2018 2018 2024 2025: prominence of the left optic nerve sheath 

Presumptive diagnosis from my colleague was unilateral papilledema. Tried diamox 250mg Feb2017 qid but caused renal impairment egfr 69 down to 55.  

Overall diamox seems to be able to reduce the RNFL. 

Diamox was ceased and disc swelling recurred and had Optic nerve sheath fenestration  25Sep2018 od The oculoplastics surgeon states when he cut into the sheath – CSF flowed freely like 'Niagra falls'.  

17May18 (pre ONSF) OCT RNFL 125um od 100 um os      6Nov18 Post ONSF OCT RNFL 93 um od 107um os             

25Nov2024 OCT RNFL 172um od 102um os  

7Jan25 MRI – Hypoplasia of the left transverse sigmoid sinus with possible narrowing at the right sigmoid transverse junction. Flattening of the posterior sclera right >left . Has moderate fluid within the optic nerve sheath,.  

16May25 od