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TitleCreatorHistory
226 Not a Meatball - Path PPTSteven Newman; James Mandell; Colleen Druzgal; John Jane Jr.; Spencer Payne; Sugoto Mukherjee; Beatriz LopesIn April 2015, a 10 year old girl was referred for a four day history of ptosis and double vision. On examination, visual acuity was 20/20-OU; near vision was 3pt OU. Visual fields showed subtle arcuate visual field changes. External examination revealed palpebral fissures of 6.5 and 9 with an upper...
227 In The Thick of It - Path PPTKannan Narayana; Ritesh Ramdhani; Bradford Tannen; Laura Balcer; Steven Galetta; Janet RuckerA 38 year-old woman with a history of premature birth with significant developmental delay was sent for neuroophthalmic evaluation for excessive head movements with gaze shifting. As an adult, she was verbal and able to take the bus alone to a day program. Over the past two years, language and cogni...
228 Looking for a Drop of Porcelain - Path PPTShannon 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...
229 Eyes and Bowels Bottled Up - Presentation PPTKristopher Kowal; Jonathan D. Trobe; Theodore T. BrownA 56 year-old man presented with diplopia and ptosis. Actually he was more concerned about severe constipation that had started about the same time. Abdominal x-rays had shown stool loading; laxatives had been ineffective. Our exam showed bilateral ptosis with complete ophthalmoplegia in both eyes. ...
230 Some Like it HotAhmara G. Ross; Islam Zaydan; Gabrielle Bonhomme; Ellen Mitchell; Tarek Shazly; Deborah ParrishA 71 year old Caucasian man with a past medical history of hypertension, hyperlipidemia, Type 2 DM, ESRD status post renal transplant, facial melanoma, currently on ASA for a stable left sided putaminal hemorrhage presented with new right sided ptosis and lower extremity weakness. Brain MRI obtained...
231 Three Weeks in FloridaAndrew R. Carey; J. Antonio Bermudez-Magner; Sander R. Dubovy; Norman J. Schatz; Linda L. Sternau; Byron L. LamA 36 year-old man presented with severe headaches, bilateral leg numbness, and bilateral decreasedvision. He was born in Ecuador where he received BCG vaccination and immigrated to US at age 19. In2005 he enrolled in nursing school and volunteered in homeless shelters. PPD was positive with anegativ...
232 Under PressureNathan H. Kung; Collin M. McClelland; Gregory P. Van StavernA 29-year-old woman was referred to neuro-ophthalmology clinic for 1 year of headaches andpapilledema discovered 2 months earlier. She complained of recently blurred vision but no positionalheadache, pulsatile tinnitus, transient visual obscurations, or other neurologic issues. She used nomedication...
233 Shady Double CrosserFrancine WeinA 62-year-old woman presented with a one-month history of severe light sensitivity and headache, and atwo week history of diplopia. Her photophobia was severe enough for her to wear sunglasses indoors.Her past medical history was significant for a cholecystectomy and Crohns disease, for which she ha...
234 A Shot in the DarkJoshua Pasol; Ricardo Komotar; Feisal YamaniA 74 year-old man with a chief complaint of difficulty with night time driving for several years as wellas difficulty going from a lighted room to a dark room. PMH of high cholesterol, BPH, hypothyroidism,GERD, glottic squamous cell cancer without recurrence, and a prior history of alcoholism. POHx:...
235 It's Not Just a FAD, (EHR Fatigue Syndrome)Jacqueline A. Leavitt; John J. Chen; Diva R. SalomaoA 29 year-old female nurse, nine months postpartum, presented with an inability to see her computerwell for the past two months. She denied eye pain, diplopia, numbness, tingling or weakness. Therewere no changes in vision in bright vs. dim lighting. She also had a headache at the back of her head f...
236 A Weak PresentationReuben M. Valenzuela; Bradley Katz; Alison Crum; Kathleen B. Digre; Nick Mamalis; Hans C. Davidson; Judith WarnerAn 82-year-old right-handed man with myasthenia gravis presented in May 2014 with double vision andright facial numbness and weakness. He was first seen in 1998 with horizontal diplopia. He had anabduction deficit of the right eye, and right nasolabial fold flattening. He was diagnosed withmyastheni...
237 Using MuscleNagham Al-Zubidi; John E. Carter; Bundhit Tantawongski; Patricia Chevez-Barrios; Lyndon Tyler; Constance L. FryA 30- year-old Saudi female student with no past medical history presented an eight month history ofprogressive blurred vision primarily at near, anisocoria OS, and periocular discomfort with eyemovements. Neuro-Ophthalmologic examination revealed best corrected visual acuity of OD 20/20 andOS 20/30...
238 Some Like it HotAhmara G. Ross; Islam Zaydan; Gabrielle Bonhomme; Ellen Mitchell; Tarek Shazly; Deborah ParrishA 71 year old Caucasian man with a past medical history of hypertension, hyperlipidemia, Type 2 DM,ESRD status post renal transplant, facial melanoma, currently on ASA for a stable left sided putaminalhemorrhage presented with new right sided ptosis and lower extremity weakness. Brain MRI obtainedon...
239 Requiem for a Cabinet MakerJennifer I. Doyle; Michael S. Vaphiades; James R. Hackney; Lanning B. Kline; Lina NagiaA 54-year-old white male presents with 3 weeks of painless horizontal nystagmus and 6 months of leftsided forehead numbness. He reports a 20 lbs weight loss. Medical history includes a renal transplant 30years prior. He takes prednisone 30 mg QOD and azathioprine. Visual acuity is 20/20 OU, color vi...
240 Growing SuspicionAngela M. Herro; Norman J. Schatz; Linda L. Sternau; John R. GuyA 44 year-old man presented to the emergency department in July 2011 for progressive painless visionloss in the right eye for 3 months. On presentation, vision was 4/200 in the right and 20/20 in the leftwith an afferent pupillary defect on the right. His visual field was full to confrontation but a...
241 Who Deserves a Second Chance?Lina Nagia; Jennifer Doyle; Lanning KlineAn 81-year-old woman presents with a one-month history of blurred vision OS, acutely worse in thepast 5 days. She reports pain with left gaze, left sided forehead tenderness and some weightloss. Medical history includes hypertension, borderline diabetes, cerebral vascular accident and basalcell carc...
242 I Can't See StraightSteven A. Newman; T. Ben AblemanIn May of 2014 this 30 year old right handed patient was referred for consultation regarding diplopiaand dizziness. The patient relates that she had been told that she had tired eyes as a child. Two and ahalf years ago she began to have intermittent exodeviation. She was seen locally and diagnosed a...
243 Hiding and Out of SightMichael L. Morgan; Sumayya J. Almarzouqi; Patricia Chevez-Barrios; Amina I. Malik; Andrew G. LeeA 75-year-old white woman presented with a history of biopsy-proven giant cell arteritis (GCA)presented with recurrence of severe left sided headaches and left global ophthalmoparesis for 4 days.GCA had been diagnosed 4 months prior by biopsy. Left eye vision loss occurred when an outsidephysician t...
244 Star Spangled BannerDara M. Bier; Jeffrey P. Greenfield; Marc K. Rosenblum; Joseph Comunale; Cristiano Oliveira; Marc J. DinkinA 12-year-old girl with a history of bilateral optic nerve enlargement, enterovirus meningitis, seizures,and bilateral hygromas, presented with acute onset chronic vision loss in her left eye. Two years prior,she presented to an outside hospital with headaches, intermittent speech arrest and right-s...
245 Lights OutJohn J. Brinkley; John J. Chen; Patricia A. Kirby; Reid A. Longmuir; Matthew J. ThurtellA 78 year-old man presented with a one-month history of progressive painless binocular vision loss. Hehad sustained head trauma without loss of consciousness three days prior to the onset of vision loss. Onthe morning of his presentation to us, he had awoken with complete binocular vision loss and h...
246 Joe & Jerry Flew the CoopLulu L.C.D. Bursztyn; Dane A Breker; Andrew W. Stacey; Ashok Srinivasan; Mark W. Johnson; Jonathan D. TrobeA previously healthy 13-year-old girl presented to a local hospital with fever and myalgia, followed oneday later by lethargy and vision loss. Past medical history was significant only for acne, for which shehad been treated with doxycycline 40 mg/day intermittently starting 2 months prior to sympto...
247 The Man with No Face (About Face)Michael Vaphiades; Jennifer Doyle; Lina Nagia; Kevin Bray; Kline Lanning; Glenn Roberson; Adam Quinn; Joel Cure; Katherine FeningA 61-year-old man presented with one week history of decreased vision OS. Past medical historyincludes asthma and amblyopia OD, but with complete visual loss OD 18 years prior. He takes nomedications. He is retired but worked for 21 years in social science research. The remarkable thingupon meeting ...
248 SpeakeasyJoseph G. Chacko; Marcus Moody; Harry H. Brown; Sarkis NazarianA 64 year-old Caucasian gentleman presented with an unusual complaint. He stated that if he touchedthe inside of his right cheek with his tongue, he felt a tingly sensation in his R eyebrow. This had startedone month ago. He also complained of foreign body sensation and discomfort in the right eye f...
249 Nobody's PerfectAlexander Ksendzovsky; Steven A. NewmanIn June of 2006 an 8 year old patient was referred for evaluation. Apparently at age 1she haddeveloped headaches and was found to have a posterior fossa tumor. In El Salvador she was treatedwith shunting and chemotherapy plus radiation therapy for presumed medulloblastoma. She underwenta shunt revis...
250 Now you see it. Now you don't.Prem S. SubramanianA 70 yo RH African American female presented to our institution with sequential, severe vision loss inthe preceding 4 months. Her past medical history included well-controlled hypertension andhyperlipidemia, CAD s/p coronary stent placement x 2 after MI, and stroke. She had no prior history ofvisual...
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