| Identifier |
walsh_2018_s1_c5-2 |
| Title |
What Don't You See? - Slides |
| Creator |
James O'Brien; R. Michael Siatkowski |
| Affiliation |
(JO) (RMS) Dean McGee Eye Institute / The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma |
| Subject |
See saw nystagmus(, MRI, Optic chiasm, Afferent visual pathways |
| History |
A four-year old male presented for evaluation of abnormal eye movements and strabismus which had been present since approximately 6 weeks of age. He was previously diagnosed with nystagmus, ocular torticollis, and esotropia by another provider. An MRI of the brain was performed at approximately 4 weeks of age. The study was reportedly normal, but it was unavailable for our direct review. He underwent right medial rectus recession and right lateral rectus resection for esotropia at age 3. His parents reported exotropia following this strabismus surgery. His medical history otherwise included valve-sparing repair of Tetralogy of Fallot, repair of esophageal atresia, and tracheoesophageal fistula repair. Examination revealed uncorrected visual acuity of 20/200 OD and 20/100 OS. This was not improved by cycloplegic refraction: +2.00 +1.00 x70 OD and +2.00 +1.00 x105 OS. His pupillary exam and gross visual fields by confrontation were normal. His ocular motility revealed pendular nystagmus with predominantly horizontal waveforms but occasional super-imposed see-saw waveforms as well. He had A-pattern exotropia of 8, 15, and 25 prism diopters in up-, primary-, and down-gaze, respectively, with chin-down head posture. There was bilateral overdepression in adduction on motility testing. Anterior segment and dilated fundus examinations were normal bilaterally. A diagnostic test was ordered. (A video demonstrating his ocular motility will be shown) |
| Disease/Diagnosis |
See-saw nystagmus secondary to Achiasma |
| Presenting Symptom |
A four-year old male presented for evaluation of abnormal eye movements and strabismus which had been present since approximately 6 weeks of age. He was previously diagnosed with nystagmus, ocular torticollis, and esotropia by another provider. An MRI of the brain was performed at approximately 4 weeks of age. The study was reportedly normal, but it was unavailable for our direct review. He underwent right medial rectus recession and right lateral rectus resection for esotropia at age 3. His parents reported exotropia following this strabismus surgery. His medical history otherwise included valve-sparing repair of Tetralogy of Fallot, repair of esophageal atresia, and tracheoesophageal fistula repair. Examination revealed uncorrected visual acuity of 20/200 OD and 20/100 OS. This was not improved by cycloplegic refraction: +2.00 +1.00 x70 OD and +2.00 +1.00 x105 OS. His pupillary exam and gross visual fields by confrontation were normal. His ocular motility revealed pendular nystagmus with predominantly horizontal waveforms but occasional super-imposed see-saw waveforms as well. He had A-pattern exotropia of 8, 15, and 25 prism diopters in up-, primary-, and down-gaze, respectively, with chin-down head posture. There was bilateral overdepression in adduction on motility testing. Anterior segment and dilated fundus examinations were normal bilaterally. A diagnostic test was ordered. (A video demonstrating his ocular motility will be shown) |
| Date |
2018-05 |
| References |
1. Dell'Osso LF, Williams RW. Ocular motility abnormalities in achiasmatic mutant Belgian Sheepdogs: unyoked eye movements in a mammal. Vis Res 35:109-116, 1995. 2. Victor JD, Apkarian P, Hirsch J, et al. Visual function and brain organization in non-decussating retinal-fugal fibre syndrome. Cerebral Cortex 10:2-22, 2000. 3. Balani A, Kumar AD, Marda SS, et al. Nondecussating retinal-fugal fibre syndrome: clinical and neuroimaging clues to diagnosis. Indian J Ophthalmol 63:858-861, 2015. 4. Korff CM, Apkarian P, Bour LJ, et al. Isolated absence of optic chiasm revealed by congenital nystagmus, MRI, and VEPs. Neuropediatrics 34:219-223, 2003. 5. Jansonius NM, van der Vliet TM, Cornelissen FW, et al. A girl without a chiasm: electrophysiologic and MRI evidence for the absence of crossing optic nerve fibers in a girl with congenital nystagmus. J Neuro-Ophthalmol 21:26-29, 2001. |
| Language |
eng |
| Format |
application/pdf |
| Format Creation |
Microsoft PowerPoint |
| Type |
Text |
| Source |
2018 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2018 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2018. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6ng8tzr |
| Setname |
ehsl_novel_fbw |
| ID |
1326574 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6ng8tzr |
