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1 Is the Treatment Working? Yes, the Patient Is Getting Worse!Walid Bouthour, Heimo SteffenA 46-year-old woman from Gambia with no prior medical history presented to the ophthalmology clinic for progressive; blurred vision, headache, and weight loss over the past two months. Her best corrected visual acuity was finger count in the; right eye and 20/20 in the left eye. There was an asymmet...
2 Hydrocephalus Appetizer, TED Entrée, Side of Bipolar Disease. Would You Like a Meatball With That?Eric Caskey, Bradley Katz, Bhupendra Patel, Roger Harrie, Meagan Seay, Benjamin Witt, Yoshimi Anzai, Alison Crum, Judith Warner, Kathleen DigreA 74-year-old man presented with a one year history of progressive, asymmetric proptosis. His past medical history by bilateral optic neuropathy, thyroid eye disease complicated by lithium treatment for bipolar disease, benign prostatic included hydrocephalus associated with aqueductal stenosis, sta...
3 WD-40: A Multi-Use ProductGeorgia Kaidonis, Melike Pekmezci, Jessica Van Ziffle, Jonathan HortonA 15-year-old female with a history of syndactyly, brachydactyly and patent ductus arteriosus presented with declining; vision and new onset of headache. She was referred for neuro-ophthalmology evaluation. Best corrected acuity was 20/40; in the right eye and 20/100 in the left eye. The pupillary r...
4 Just a Flu?Lily "Tali" Okrent Smolar, Veronika Yehezkeli, Fani Segev, Feda Fanadka, Sachin Kedar, Yehoshua AlmogA thirteen-year-old boy with no significant past medical history presented to the pediatric emergency department (ED) with; progressive right eyelid swelling, decreased appetite, general malaise and obtundation. A week prior to presentation, he; had flu like illness with fever, headache, ear pain, n...
5 Some Heads Are Harder Than OthersSteven A. NewmanA 56 year old right handed patient was referred for an "orbital problem." Ten years earlier he had been told that nothing; could be done about the fact that his right eye position was not normal. In August 2015 vision was 20/50 OD and 20/300; OS, with the decreased vision on the left felt related to...
6 The Grey Area of White MatterParker Bohm, Leanne Stunkel, Gregory Van StavernA 76 year-old man presented with two months of progressive confusion, vision loss, and left-sided weakness. His medical; history was notable for hypothyroidism, type 2 diabetes mellitus, coronary artery disease, basal cell carcinoma of the; forehead status-post excision, deep vein thrombosis, and se...
7 Waiting for That ‘Bing' Moment to Get the DiagnosisJenny Hepschke, J. Virdee, Richard Blanch
8 Waiting for That ‘Bing' Moment to Get the DiagnosisJenny Hepschke, J. Virdee, Richard BlanchA 55yo Caucasian female initially presented to her GP with a new onset headaches, scalp tenderness, shoulder arthralgia,; night sweats and loss of appetite. Bloods platelets of 379, ESR 26 and CRP of 4. She was diagnosed with Giant cell arteritis; (GCA) and empirically treated with oral Prednisolone...
9 Not Another IgG4 Case!Anne R. Kao, MDA 34 year-old woman was referred from the allergist for painless swelling of bilateral upper eyelids for 11 months, after; moving from Alabama to her current state of residence. Her past medical history was significant for anemia. Review of; systems was notable for fatigue, daily headaches, and inte...
10 Pseudo-Pseudotumor Cerebri?Etienne Benard-Seguin, Abdullah Al-Ani, Kris Langdon, Rajiv Midha, Paula de Robles, Fiona CostelloA 23-year-old female to male transgender patient (BMI=30) on testosterone therapy presented to the urgent clinic with; bilateral disc swelling and preserved optic disc function (Figure 1a-1b). He had a 5 day history of general malaise. Past; medical history was pertinent for scoliosis surgery at age...
11 The Nidus of the NeuropathyHeather McDonald, Adrian Budhram, J Alexander Fraser, Lulu LCD BursztynA 57-year-old female presented with a one-year history of paresthesias, gait instability, slurred speech, peripheral; numbness, and fatigue. A non-contrast CT Head showed lower density in the corpus callosum. Follow-up MR Head showed; T2/FLAIR hyperintensity and diffusion restriction in the splenium...
12 An Apple a DayJoseph Fong, James O'Brien, Anil PatelA 73-year-old female presented with a 4-month-history of gradually worsening binocular oblique diplopia, right upper; eyelid ptosis, right-sided facial weakness, and facial pain and paresthesia in the right V1 and V2 distribution. She presented; with a prior diagnosis of trigeminal neuralgia as a re...
13 The Inconspicuous CystsLily Zhang, Folusakin Ayoade, Julio Diaz PerezA previously healthy 40-year-old male, with a past medical history significant for latent tuberculosis s/p treatment 15 years; ago, presented with blurry vision and progressively worsening headaches for 6 months. He was originally from Guatemala; and moved to the US in 2001 (crossed the deserts thro...
14 Thinking Outside of the LinesCarleigh Bruce, Thomas Clark, Gregory Griepentrog, Andrea Stahulak, Mariam RatianiA 61-year-old male with past medical history of long-standing cocaine abuse presented with ten days of painless acute; vision loss in his right eye (OD). Initial exam revealed a visual acuity (VA) 20/100 OD, relative afferent pupillary defect; (rAPD) OD, dyschromatopsia OD, hypertropia with impaired...
15 Double CrossedJeffrey Gluckstein, Melanie Lang-Orsini, Joseph RizzoA 58-year-old man presented for the development of new stabbing headaches and blurry vision in the right eye. Over; several months, his symptoms progressed to "smudging" of his temporal field in the right eye, difficulty separating similar; colors, and binocular horizontal diplopia worse at near. Me...
16 All in the FamilyHomer Chiang, Shannon BeresA previously healthy 2-year-old male presented to neuro-ophthalmology clinic for a head turn that started 1.5 months ago; and his left eye began turning in over the last 2 weeks. He had no recent infections, vaccinations, or illnesses. With the birth; of his new baby sister 6 weeks prior the family ...
17 A Nod to the NoduleNatalie Brossard, Kirill Zaslavski, Laila Al-Shafai, David Munoz, Edward MargolinA 67-year-old man presented to emergency department in March'21 with 6hours h/o fever, headache, confusion, right- sided weakness and urinary incontinence. He had h/o hypertension, rheumatoid arthritis, spinal stenosis and was taking etanercept/leflunomide/sulfasalazine. Non-contrasted CT showed lef...
18 A Nod to the NoduleNatalie Brossard, Kirill Zaslavski, Laila Al-Shafai, David Munoz, Edward MargolinA 67-year-old man presented to emergency department in March'21 with 6hours h/o fever, headache, confusion, right- sided weakness and urinary incontinence. He had h/o hypertension, rheumatoid arthritis, spinal stenosis and was taking etanercept/leflunomide/sulfasalazine. Non-contrasted CT showed lef...
19 A Nod to the NoduleNatalie Brossard, Kirill Zaslavski, Laila Al-Shafai, David Munoz, Edward MargolinA 67-year-old man presented to emergency department in March'21 with 6hours h/o fever, headache, confusion, right- sided weakness and urinary incontinence. He had h/o hypertension, rheumatoid arthritis, spinal stenosis and was taking etanercept/leflunomide/sulfasalazine. Non-contrasted CT showed lef...
20 Hydrocephalus Appetizer, TED Entrée, Side of Bipolar Disease. Would You Like a Meatball With That?Eric Caskey, Bradley Katz, Bhupendra Patel, Roger Harrie, Meagan Seay, Benjamin Witt, Yoshimi Anzai, Alison Crum, Judith Warner, Kathleen Digre
21 Is the Treatment Working? Yes, the Patient Is Getting Worse!Anne R. Kao, MD
22 The Inconspicuous CystsLily Zhang, Folusakin Ayoade, Julio Diaz Perez
23 Pseudo-Pseudotumor Cerebri?Etienne Benard-Seguin, Abdullah Al-Ani, Kris Langdon, Rajiv Midha, Paula de Robles, Fiona Costello
24 A 4-Year WaitDmitry Balian, Sachin Kedar, Michaelyn Everhart, Aleh Bobr, Liudmila MuinovA 64 year old male with past history of hypertension, arthritis and chronic headache developed transient tingling and numbness of his left face in February 2016 and was diagnosed to have "trigeminal neuralgia". Two months later, he presented to the ED with sudden onset of binocular tilted diplopia. ...
25 Frizzle FrazzledEric D. Gaier, Farrah Rajabi, Anne Fulton, Gyula Acsadi, David WaitzmanAn otherwise healthy 12-year-old boy originally from Palestine was referred for refractory papilledema secondary to familial IIH. He has a history of fully accommodative esotropia with onset age 2-3. At age 9, elevated optic nerves prompted a neuro-ophthalmic referral. Best corrected visual acuities...
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