NOVEL - Shirley H. Wray Collection
 
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1 Palatal TremorThis patient presented with an acute brainstem stroke with: 1. A unilateral lower motor neuron (LMN) facial palsy on the right 2. A horizontal gaze palsy to the right 3. Mild unsteadiness walking The infarct localized clinically to the right side of the pons involving the abducens nucleus and the g...Image/MovingImage
2 Downbeat NystagmusThis patient carries a diagnosis of Type I Chiari malformation. Neurological symptoms of a Chiari malformation may not develop until adolescence or adult life as in this man. The symptoms may be those of: 1. Increased intracranial pressure, mainly headache 2. Progressive cerebellar ataxia 3. Progre...Image/MovingImage
3 Ocular DippingThe patient is a 32 year old woman with juvenile diabetes mellitus. She collapsed at home and was rushed to the emergency room where a diagnosis of a locked-in syndrome was made. The term Locked-in Syndrome (LiS) was coined in 1966 by Plum and Posner for a condition with the following criteria: 1....Image/MovingImage
4 Lid LagThe classical eye signs of thyroid associated ophthalmopathy (TAO) of Graves' Disease is illustrated by case ID925-4. This 50 year old woman with TAO is included in the collection because she illustrates very well lid lag (persistent elevation of the upper eyelid in downgaze) - von Graefe sign E...Image/MovingImage
5 Third Nerve PalsyThis patient is a 58 year old woman from Peru who, in 1975, developed intermittent headaches and right retro-orbital eye pain. She was seen by several ophthalmologists in South America who were unable to make a diagnosis. In March 1977 she awoke one morning with vertical diplopia most marked on...Image/MovingImage
6 PalinopsiaThe patient is a healthy 59 year old woman who presented in 1978 with transiet visual symptoms. The first visual disturbance occurred in December 1978 when suddenly she noted: • Fluttering of vision in the left eye (OS) • The appearance of a central black spot • Around the edge of the blac...Image/MovingImage
7 Retinal EmboliTemporary loss of vision in one eye, termed transient monocular blindness (TMB), is the most important visual symptom of arteriosclerotic vascular disease, arteritis and states of altered coagulability and thrombocytosis. In most patients, the visual disturbance during each individual attack of ...Image/MovingImage
8 Sixth Nerve PalsyThe patient is a 45 year old pharmaceutical executive who, nine days prior to admission, flew back from San Francisco after a hectic business trip feeling jet lagged and fatigued. Inspite of this, four days later, he did a day trip to New York. On the following morning, a Saturday, he awoke with ...Image/MovingImage
9 MS Time Lapse MRIProfessor Ian McDonald, Institute of Neurology, Queen Square, London contributed this remarkable Time-Lapse MRI of focal MS lesions in a single patient with multiple sclerosis over a period of one year. This time lapse video was assembled from serial T2- weighted MRI scans from a 25-year old wo...Image/MovingImage
10 Migraine / PET StudyIn December 1994 the New England Journal of Medicine published a remarkable paper Bilateral Spreading Cerebral Hypoperfusion during Spontaneous Migraine Headache. Roger P. Woods, Marco Iacoboni and John C. Mazziotta. which is reproduced in part, and accompanied by a video illustration. Courtesy of J...Image/MovingImage
11 Oculomasticatory MyorhythmiaThis case, previously reported in 1986, is published courtesy of John Selhorst, M.D., Saint Louis University School of Medicine, St. Louis, MO. (4) The patient is a 46 year old man who, over a period of six months, lost the ability to read and complained of excessive somnolence, occasional urinary i...Image/MovingImage
12 Jaw WinkingThis young boy was born at full term after a normal pregnancy with congenital unilateral ptosis of the left eyelid. His mother noticed that when he was sucking on a bottle the ptotic eyelid opened and closed. A diagnosis of the Marcus-Gunn jaw winking phenomenon was made. The first case of thi...Image/MovingImage
13 Hemifacial Spasm: Eyelid TwitchingThis patient is an atypical case of hemifacial spasm because he is a young college student only 29 years of age. Hemifacial spasm usually develops in the fifth and sixth decade of life and affects women more than men. It often begins insidiously in the orbicularis oculi muscle in the early stage...Image/MovingImage
14 LateropulsionThis 44 year old woman has a diagnosis of Multiple Sclerosis.Image/MovingImage
15 Benign Essential BlepharospasmPatient is a 55 year old woman functionally blind from severe benign essential blepharospasm. She presented with frequent blinking.continuous spasms of eye closure and great difficulty opening her eyes i.e. blepharospasm associated "apraxia of eyelid opening". Symptomatic Inquiry negative for...Image/MovingImage
16 Congenital Ocular Motor ApraxiaThis little boy was born at term after a normal pregnancy. There was no family history of a neurological or ophthalmological disease. His mother noted from birth that he turned his head instead of his eyes and frequently tried to fix objects on either side by making a quick turn of the head past...Image/MovingImage
17 Congenital Ocular Motor ApraxiaThis baby was born at term after an uneventful pregnancy and normal delivery. He was the first and only child. There was no family history of any This baby was born at term after an uneventful pregnancy and normal delivery. He was the first and only child. There was no family history of any neurol...Image/MovingImage
18 Ocular FlutterThis little boy complained of difficulty focusing. On examination he was found to have ocular flutter. He was otherwise neurologically intact and in good general health. Investigations were directed to rule out 1. Neuroblastoma (see ID 936-8) 2. Enterovirus infection 3. Parainfect...Image/MovingImage
19 Congenital Ocular Motor ApraxiaThis 3 year old boy was referred for evaluation of inattention. He was born at term after a normal pregnancy. He had been noted, in early childhood, to have difficulty looking to the right and to the left and was slow to read.Image/MovingImage
20 Ocular Motor ApraxiaThis elderly patient was referred to the Movement Disorder Clinic for evaluation of abnormal head thrust movements when asked to look on command to the right or to the left. His random eye movements were full vertically and horizontally. Diagnosis: Acquired Ocular Motor Apraxia ...Image/MovingImage
21 Congenital Horizontal Gaze PalsyThe patient is an 8 year old boy with a rare autosomal recessive disorder characterized by congenital absence of conjugate horizontal eye movements preservation of vertical gaze and convergence and progressive scoliosis (HGPPS) developing in childhood. The child was referred to Dr. Cogan with a ...Image/MovingImage
22 Supranuclear Paralysis of UpgazeThis young child presented with headache and unsteadiness. He was found to have obstructive hydrocephalus, aqueduct stenosis and a medulloblastoma. The constellation of clinical eye signs localized to the Dorsal Midbrain and included: • Supranuclear paralysis of upgaze (saccadic and pursuit move...Image/MovingImage
23 Unilateral PtosisThe patient is a 46 year old woman who presented in July 1977 with horizontal double vision lasting two weeks. Three weeks later the left upper eyelid started to droop and by the end of the day the eye was closed. She had no ptosis of the right eye and no generalized fatigue. She consulted an in...Image/MovingImage
24 Bilateral PtosisThe patient is a 65 year old physician who presented with intermittent drooping of his eyelids, particularly at the end of the day. He found that if he gently closed his eyes when he came to a stop in his car at a set of traffic lights, his eyelids opened more fully. He subsequently developed inte...Image/MovingImage
25 Pseudo-Internuclear OphthalmoplegiaIn 1969 this 54 year old man presented with a one month history of blurry vision which started suddenly one afternoon. He said he was "just not focusing" and he saw two images when he "relaxed his sight". He could see clearly covering one eye. Initially, the difficulty in focusing occurred la...Image/MovingImage
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