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TitleCreatorHistory
1 The Path of Least Resistance: Over the Nose, Into the Orbit, and Around the GlobeSahar Noorani; Ali Tejani; Mingyi Chen; Melanie Truong-LeTo determine a definitive diagnosis, biopsy of the left lateral rectus muscle was planned. Given the improvement seen on imaging and to optimize biopsy yield, the patient was weaned off steroids. However, he deteriorated almost immediately after cessation of steroids and developed worsening diplopia...
2 Losing Vision, Losing SleepBart Chwalisz; Aditi Varma-Doyle; Jenny LinnoilaCSF indirect immunofluorescence assay was positive for IgLON5 (Immunoglobulin-like cell adhesion molecule-5) antibodies at 1:8 titer, confirmed by cell-based assay. After completion of a subsequent steroid taper, given symptomatic progression, the patient's treatment regimen was escalated to monthly...
3 It Can't Be Me, But … Maybe it's Both of Us?George Park; Steven Galetta; Laura Balcer; Janet Rucker; Leah Geiser Roberts; Arline Faustin; Nithisha Prasad; Ariane Lewis; Timothy Shepherd; Mark Finkelstein; Scott GrossmanThe patient presented with progressive positional headaches, likely related to presumed increased intracranial pressure, along with a left 6th nerve palsy. The process was likely related to local inflammation/compression with initial imaging showing a left petroclival lesion with extension into the ...
4 Orbitally VexedBlake Colman; Rogan Fraser; Evelyn Perry; Prashanth Ramachandran; Shivanand Sheth; Neil Shuey; Subahari RaviskanthanGenetic testing had revealed a Mel41Val missense mutation in a gene located in the UBA1 gene on the X- chromosome, in keeping with a diagnosis of VEXAS syndrome. Pulsed intravenous methylprednisolone resulted in rapid improvement of symptoms with only mild abduction restriction, temporal conjunctiva...
5 Headache and Visual Deficits: Ironing Out the DetailsAmalie Chen; Leigh Rettenmaier; Andres Santos; Mariel Kozberg; Sashank PrasadMRI brain with gadolinium contrast revealed diffuse leptomeningeal enhancement, most prominently in the bilateral temporal parieto-occipital and left frontal sulci (Fig.1), with associated T2/FLAIR sulcal hyperintensity (Fig.2). T2-weighted images showed enlarged perivascular spaces (i.e. Virchow-Ro...
6 Atypical Case of Optic Nerve Head Edema: Painful, Enhancing and TreacherousSamir Touma; Katie Luneau; Jacinthe RouleauA cerebral MRI was done showing impressive enhancement of the intraorbital portion of the right optic nerve sheath with diffuse swelling of the optic nerve suggestive of optic neuritis. There was no extension to the optic chiasm and no infiltrative or demyelinating lesion. A retinal angiography reve...
7 MY-OH-MY Just a Drop will DoMark Aurel Nagy; John Gonzales; Thuy Doan; Jay Stewart; Annemieke Vanzante; Nailyn RasoolThe patient initially presented with progressive intraocular inflammation and uveitic glaucoma. He reported headaches, weight loss, depression and changes in his libido. Upon examination, the patient's mental status was altered, being somnolent, slow to answer questions, with continuous hiccups and ...
8 Devine InterventionLetitia Pirau; Wayne Cornblath; Lindsey De Lott; Sangeeta Khanna; Tatiana DeveneyA 30 yo woman presented to the comprehensive ophthalmology clinic with bilateral decreased vision. She had no prior ocular history. Her medical history was notable for breast cancer (diagnosed 1 year prior), treated with radiation, chemotherapy, lumpectomy, and pembrolizumab (completed 8/9 planned i...
9 Go Back to the House, MDMarc BouffardCSF examination revealed 0 WBC, 1 RBC, protein 78, and a glucose of 96. MRI brain revealed FLAIR hyperintensities in the brainstem, basal ganglia, and subcortical white matter without abnormal post-contrast enhancement or diffusion restriction. The history was revisited with a painstaking "yes/no" i...
10 A White Matter Riddle Encased in Mystery, Coiled Inside an EnigmaNathan Tagg; Elizabeth Rooks; Vanessa Smith; Thomas CummingsA 59-year-old woman was admitted for evaluation of progressive paranoia and was treated for bipolar disorder. An MRI during evaluation revealed a 10 x 7 x 7 mm right MCA aneurysm. She underwent stent-assisted coil embolization nine months later without immediate complications. Four months post-proce...
11 Double Double, Toil and TroubleKevin Yan; Adeniyi Fisayo; Joachim Bähring; Declan McGuoneThe patient's symptoms are all related to her multiple intracranial lesions, with the left cavernous sinus lesion being the most symptomatic and resulting double vision and jaw numbness. The lower motor neuron pattern left facial weakness is likely attributable to posterior extension of the lesion a...
12 Anchora SellaAdeniyi Fisayo; Vanessa VelosoOn August 3, 2023, endoscopic endonasal resection of the sellar mass revealed a soft hemorrhagic mass within the sphenoid sinus, sellar and suprasellar spaces. Gross appearance of the mass was atypical for meningioma while frozen section revealed malignant, metastatic appearance. Final pathology rev...
13 How to Get the Red OutRaghu Mudumbai; Courtney Francis; Eugene MayPrior testing included C3, C4 normal, RF neg, ANA neg, MPO/PR3/ANCA neg HLA b27 neg, CCP neg, Hsv1 igG positive, Hga1c 6.3, ACE normal, HIV negative. An angiogram to evaluate for C-C fistula which was negative. MRI of the Orbits indicated Nodular enhancement along the left optic nerve with repeat im...
14 (Don't) Blame it on RioAvital Lily Okrent Smolar; Andre Aung; Fernando Labella Alvarez; Aliaksandr Aksionau; Stewart Neill; Sachin KedarA 43-year-old woman experienced blurred vision and pulsatile tinnitus after gaining 20 lbs. Six months later, optometric evaluation showed normal vision and bilateral optic nerve swelling. MRI brain with and without contrast was reportedly normal. One month later, she underwent a "Brazilian butt lif...
15 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...
16 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...
17 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...
18 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...
19 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 ...
20 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...
21 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...
22 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...
23 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...
24 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...
25 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...
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