A 34 year old medical secretary whose present complaint began about 1 month ago with a headache in the left temple area. These was somewhat recurrent and sever enough to keep the patient awake. She also developed independently of this headache a aura pf geometric shapes in the right field. These had red and blue colors. They lasted about 10 minutes and then transmuted into wavy, moving lines. She dose not think she had headaches at this time. These episodes have been repeated 3 times. There have been no hallucination, but on awakening at least on one occasion she was some bright spots in the right field. She denies hallucinations or abnormal dreams. She was not aware of hemianopia until she ran off the road with her car. Since then the vision in the right field was progressively decreased. Neuralgic examination is said to be negative, but the EMI scan shows a large tumor in the left occipito-parietal area with marked displacement of the calcific body in the choroids plexus forward and surrounding edema. Neuralgic examination is said to be negative. The only other note of interest is that the patient's mother has Cowdin's syndrome which consists of multiple hamartomas some of which become malignant. On eye examination now the patient has a complete right hemianopia and slight relative asymmetry in the opticokinetic response, being defective on rotation to the patient's left.
Video recording made. The EGO shows asymmetry in the opticokinetic response with fatiguing more easily when the drum in rotated to the patient's left the shorter duration of the after nystagmus. With opening and closing the lids in the light there is a consistent slight deviation of the eyes to the right with closure of the eyes. * This was not tried with the patient in the dark. The EMI scan shows a large tumor in the occipital parietal area with lights up with contrast agent.
David G. Cogan, MD (1908-1993), Former Director of Ophthalmology, National Eye Institute
Fred C. Chu
U.S. Department of Health and Human Services. National Institutes of Health. National Eye Institute