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51 A Tough Nut to Crack! - VideoLauren Maloley; Sachin Kedar; Deepta Ghate; Dominick DiMaio; Jason Helvey; Sachin KedarA 47-year-old previously healthy female was transferred to our facility when she developed left abducens nerve palsy during treatment of intractable sinusitis. Two weeks prior to presentation, she developed headache and sinus congestion. She was treated with amoxicillin-clavulanic acid and prednison...
52 What Don't You See? - VideoJames O'Brien; R. Michael SiatkowskiA 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 we...
53 Whipping Up a New Flavor - VideoMeagan Seay; Tory Johnson; Benjamin Larman; Avindra Nath; Myoung-Hwa Lee; Janet Rucker; Jonathan Howard; Ilya Kister; Matija Snuderl; Laura Balcer; Steven GalettaA 43-year old Indian man presented with two years of progressive gait imbalance, dysarthria, and cognitive decline. Neurological exam revealed supranuclear gaze palsy with impaired downgaze and loss of OKN quick phases, impaired horizontal pursuit, ideomotor apraxia, facial and arm dystonia, foot an...
54 Testing the Hypophysis - VideoAlberto Distefano; Julie Cho; Adeniyi Fisayo; Mahsa SohrabA 60 year-old female with history of hypertension, hyperlipidemia, and Lyme disease 12 years ago treated with doxycycline, developed extreme thirst and polyuria four years ago and was diagnosed with central diabetes insipidus. Magnetic resonance imaging (MRI) at that time showed enhancement of the p...
55 Triple Take - VideoJohanna Beebe; Liang Cheng; Shira Simon; Michael Wall; Randy Kardon; Alkapalan Deema; Ian Han; Matthew ThurtellA 42 year-old male noticed difficulty reading labels while stocking shelves at work. Over the next three weeks, he developed a dark 'cloud' in his central vision in the left eye, and then the right eye. He did not have associated pain. When evaluated by the retina service, his visual acuities were 2...
56 When the Problem Becomes the Solution - VideoAri Shemesh; Timo Krings; Dalia Rotstein; David Munoz; Waleed Brinjikji; Laila Al Shafai; Edward Margolin25 year-old man noticed slow progressive decrease in vision in left eye. Vision was 20/20 OD and 20/40 OS, there was swelling of left optic nerve head. MRI demonstrated white matter lesions in left frontal lobe; cerebrospinal fluid composition was normal. Patient was seen in MS clinic and treatment ...
57 A Giant (Cell) Mistake - VideoBehzad Mansouri; Paul Wawryko; Frank Bovell71-year-old, left-handed woman, who was referred with ptosis, loss of vision in the right eye and headache. In July 2015 she presented to ER with severe right temporal headache and watery right eye. Her exam and head CT was normal. Her ESR/CRP were elevated. She was allegedly diagnosed with GCA and ...
58 One Peak is Worth Twenty Finesses - VideoSteven Newman; James MandellAn 8 year old was referred with a one week history of swelling around her left eye. She was not aware of any change in her vision or double vision. Visual acuity was 20/20 OD and 20/25 OS. Visual fields demonstrated minimal scattered desaturation with < ½ dB asymmetry between the two sides. Externa...
59 Uncertainty with a Twist of Lyme (video)Amrita-Amanda Lakraj; Sang Hong; Jennifer Connelly; Elizabeth CochranThe patient is a 59-year-old woman who presented with vision loss. Her ophthalmologic history is significant for; myopic astigmatism and presbyopia. Her past medical history is notable for left breast cancer (T2N0 invasive lobular carcinoma, ER/PR positive, HER2/neu negative) s/p left mastectomy, ch...
60 Papilledema Gone Wrong (video)Ahmara Ross; Payal Patel; Jessica Panzer; Grant LiuA 12 year old obese female with a history of enterovirus meningitis presented with throbbing, constant, 10/10, occipital and positional headaches, associated with diplopia, photophobia, nausea, and vomiting for one week in; the setting of a recent 20 lb. weight gain. Her vision, pupils, fields, and ...
61 A Prolonged Path To The Final Diagnosis (video)Cindy Lam; Edward MarglinPreviously healthy 25-year-old male presented with a 3-week history of frontal headache, right 3rd nerve palsy with ptosis, and areflexia of the left leg. MRI brain was normal. Two days later new symptoms developed: lower back pain, paresthesias, left leg weakness, right facial weakness.
62 Pseudo-Pseudotumor Cerebri (video)Valerie Biousse; Jose Velázquez Vega; Amit Saindane; Nancy NewmanA 54-yo man presented with a 10-month history of daily headaches and bilateral disc edema. PMHx was remarkable for uncomplicated type-2 diabetes mellitus, and hypothyroidism. He developed headaches in 07/2014 after being stung by wasps.
63 Occam Rings True (video)Reid Longmuir; Michael Bradshaw; Taylor Davis; Woon Chow; Laura Craig-Owens; Kim Ely; Katherine McDonellA 57-year-old, previously healthy man was referred for vision loss in both eyes. Six weeks before our evaluation, he presented to an outside ophthalmologist with 'greying' of the central vision in his right eye that progressed to blindness over a week.
64 A 'Frosty' Altered Level of Consciousness (video)Alaa Bou Ghannam; Emily McCourt; Victoria Pelak; Jeffrey Bennett; Prem Subramanian; David Smits15-year-old previously healthy male, transferred because of 9-day history of headache, difficulty walking, diplopia, blurry vision and new onset altered level of consciousness. Neurologic examination was remarkable for delirium; with semi-coherent speech, VA of CF 2ft and 20/400, no APD, and bilater...
65 Not Surprised Surprise (video)Yu Zhao; Joshua Pasol; Sander Dubovy; Byron LamA 68-year-old Hispanic woman presented to our emergency department with significant vision loss OS for 1 week. A month ago, she was evaluated locally for mild blurry vision OS, and corrected acuity was 20/30 OD, 20/40 OS. She was diagnosed with cataracts and epiretinal membrane OD. Medical history i...
66 Strike a Chord (video)Anastasia Neufeld; Kathleen Digre; Cheryl Palmer; H. Christian Davidson; Alison Crum; Bradley Katz; Judith WarnerA 26 year old woman presented in August 2016 with migraine over the last 4 years, getting worse over the last 2 weeks. She reported occasional 'glittering' in her vision in both eyes. She had no constitutional symptoms. Her past medical history included migraine, idiopathic leukocytosis, and nephrol...
67 Island Fever (video)Laura Hanson; Judith Warner; Alison Crum; Bradley Katz; Kathleen DigreA 22 year-old male paralegal in the military presented with double and blurred vision. One month ago, he had traveled to Hawai'i for a wedding. Two weeks ago, he had been evaluated for an acute onset of fever, headache, emesis, light sensitivity and neck stiffness.
68 A Wrong Turn at the Angle (video)Erica Archer; Jonathan Trobe; Hemant Parmar; Mohannad Ibrahim; Paul McKeever; Thomas GiordanoA 54-year-old woman developed numbness of the right jaw and right side of the tongue. She attributed her symptomatology to recent dental work, but when dental examination, including dental x-rays, failed to reveal an answer, she underwent brain MRI.
69 A Diagnostic Potpourri (video)Padmaja Sudhakar; Robert Lightfoot; Douglas Lukins; Dianne WilsonA 63 yr. old incarcerated man with history of diabetes, hypertension, rheumatoid arthritis (RA) (on hydroxychloroquine, sulfasalazine and prednisone 7 mg), cutaneous lupus and Hepatitis C presented with sudden painless vision loss of the left eye without headache or symptoms of temporal arteritis. V...
70 Alcohol is Never the Answer, but it Does Make You Forget the Question (video)Ali Saber Tehrani; Diana Londono; Thomas Rashid; Manuel Doria; Julia Biernot; Jorge KattahA 63-year old male with a history of alcohol abuse presented with two weeks of confusion and imbalance. On exam, he had left beating nystagmus on left gaze, and right beating and torsional nystagmus on right gaze. Head impulse test was abnormal in all canals bilaterally with video head impulse test ...
71 Nonchalant Midterm-taker Develops Altered Mental Status (video)Shira Simon; Bruno Policeni; Matthew ThurtellA 19 year-old female presented in April 2016 with two weeks of worsening headaches, malaise, left-hand weakness, and confusion. Symptoms started during a trip to Cancun and one week after visiting a friend with mumps. Although she was becoming increasingly lethargic, she refused to seek medical atte...
72 Keep Your Eye On the Ball (video)Danielle Rudich; Eugenia Vining; Kenneth Allen; Joel Geffin; Mena Mansour; Robert LesserIn March 2014, an 82-year-old male developed left sided facial pain and numbness over his left temple and periorbital region. He was treated for a presumed dental infection with no response. MRI brain in July 2014; showed only microvascular white matter changes.
73 M.I.A. (video)Julie DeBacker; Janet Rucker; Josef Gutman; Heather Lau; Laura Balcer; Steven GalettaA 69-year-old man presented with a several year history of vertical double vision. At age 46, he presented with a two year history of imbalance, four year history of urinary urgency/frequency, and a six-month history of leg numbness and tingling.
74 Looking for a Drop of Porcelain - VideoShannon J. Beres; Grant T. LiuA 4 year old healthy boy presented with severe headache. A right subdural hygroma was seen on brain MRI and CSF evaluation showed a leukocytosis with elevated protein. A week later he developed left leg weakness and a repeat brain MRI showed progressive leptomeningeal enhancement and new punctate in...
75 Heart of Darkness - VideoShira Simon; Shiraaz I. Rahman; John C. Heymann; Bahram Rahmani; Nicholas J. VolpeAn 18 year-old woman presented to the emergency department in October 2014 with three days of blurred vision in her left eye. Past medical history included a hypoplastic right heart status-post orthotopic heart transplant at 2 months of age, chronic kidney disease with BK viremia since 12 years of a...
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