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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 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
20 Is the Treatment Working? Yes, the Patient Is Getting Worse!Anne R. Kao, MD
21 The Inconspicuous CystsLily Zhang, Folusakin Ayoade, Julio Diaz Perez
22 Pseudo-Pseudotumor Cerebri?Etienne Benard-Seguin, Abdullah Al-Ani, Kris Langdon, Rajiv Midha, Paula de Robles, Fiona Costello
23 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...
24 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...
25 Oh My GAD!! Something Else?Olwen Murphy, Kemar Green, Olwen Murphy, John Probasco, Daniel GoldA 43 -year-old man presented with oscillopsia, dizziness, binocular vertical diplopia, and gait difficulties. He reported a six-month history of abdominal pain, anorexia and 50-pound weight loss, and a 3-month history of mood and cognitive changes. Torsional nystagmus, a left 4th nerve palsy (NP), u...
26 A Small Leak Will Sink a Great ShipKonstantinos Douglas, Vivian Paraskevi Douglas, Cameron Sadegh, David Chow, Sigurros Davidsdottir, Ganesh Shankar, Bradley Buchbinder, Bart ChwaliszA 68 -year-old right -handed man presented for evaluation of progressive and fluctuating polyopia, gait instability and cognitive changes of about 14 months. Prior medical history was notable for Crohn's disease in remission, atrial fibrillation, a single episode of aseptic meningitis 12 years prior...
27 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. ...
28 A Definite MaybeRaghu C. Mudumbai, Alex Solomon73 yo man French-Canadian presented to our institution for another opinion for a long standing diagnosis of Oculopharyngeal Dystrophy given at an outside institution. 17 years ago, the patient developed unfluctuating double vision that progressed to include severe, unfluctuating ptosis and mild dysp...
29 Orbiting a DiagnosisDaniel Liebman, Daniel Lefebvre, Emily Tam, Marie Lithgow, Bart Chwalisz, Eric Gaier, Joseph Kane
30 Never Too Young or Too OldBart Chwalisz, Laurel Tainsh, Mary Maher, Samantha Champion, Shuhei Nishiyima, Michael LevyAn 81-year-old woman with history of ocular myasthenia gravis presented with sequential bilateral vision loss. Six days before presentation, she discovered that vision of her left eye was reduced to light perception. She did not have any eye pain, pain with eye movement, headache, scalp tenderness, ...
31 A Definite MaybeRaghu C. Mudumbai, Alex Solomon73 yo man French-Canadian presented to our institution for another opinion for a long standing diagnosis of Oculopharyngeal Dystrophy given at an outside institution. 17 years ago, the patient developed unfluctuating double vision that progressed to include severe, unfluctuating ptosis and mild dysp...
32 Sometimes a Biopsy is BestKevin Chodnicki, Natalie Wolkow, Michael Yoon, Bart ChwaliszA 30 -year-old pregnant woman without significant medical or ocular history presented with decreased right eye vision. In her 2nd trimester, she was diagnosed with Lyme disease with a bulls-eye rash and positive Lyme antibodies; she was treated with two weeks of amoxicillin. At 33 weeks pregnant she...
33 "X" Marks the SpotLuis Andre Leal Ferman, Leslie Bruch, John Buatti, Jeremy GreenleeThis 24 year-old man presented with several months of progressive visual loss in both eyes. His past medical, surgical and ocular history was unremarkable. There was no family history of phacomatosis. He complained of occasional binocular diplopia, but denied headaches or any other neurological symp...
34 A Small Leak Will Sink a Great ShipKonstantinos Douglas, Vivian Paraskevi Douglas, Cameron Sadegh, David Chow, Sigurros Davidsdottir, Ganesh Shankar, Bradley Buchbinder, Bart ChwaliszA 68 -year-old right -handed man presented for evaluation of progressive and fluctuating polyopia, gait instability and cognitive changes of about 14 months. Prior medical history was notable for Crohn's disease in remission, atrial fibrillation, a single episode of aseptic meningitis 12 years prior...
35 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. ...
36 Oh My GAD!! Something Else?Olwen Murphy, Kemar Green, John Probasco, Daniel GoldA 43 -year-old man presented with oscillopsia, dizziness, binocular vertical diplopia, and gait difficulties. He reported a six-month history of abdominal pain, anorexia and 50-pound weight loss, and a 3-month history of mood and cognitive changes. Torsional nystagmus, a left 4th nerve palsy (NP), u...
37 Never Too Young or Too OldBart Chwalisz, Laurel Tainsh, Mary Maher, Samantha Champion, Shuhei Nishiyima, Michael LevyAn 81-year-old woman with history of ocular myasthenia gravis presented with sequential bilateral vision loss. Six days before presentation, she discovered that vision of her left eye was reduced to light perception. She did not have any eye pain, pain with eye movement, headache, scalp tenderness, ...
38 Orbiting a DiagnosisDaniel Liebman, Daniel Lefebvre, Emily Tam, Marie Lithgow, Bart Chwalisz, Eric Gaier, Joseph KaneA 75 -year-old male with a history of chronic/small lymphocytic leukemia (CLL/SLL) presented for one day of left retro-orbital headache, painful eye movements, eyelid swelling, and diplopia. One week prior, his WBC count was 39.9 K/uL with 86% lymphocytes. Three days prior to presentation, the patie...
39 Gone but Not ForgottenJonathan Micieli, Adriana Krizova, Walter MontaneraA 52 -year-old healthy woman presented with a 1-week history of blurred vision and "soreness" in her left eye. Neuro-ophthalmic examination revealed a visual acuity of 20/20 OD, 20/40 OS, left RAPD and left superior arcuate defect on Humphrey visual field testing. Dilated fundus examination demonstr...
40 Sometimes a Biopsy is BestKevin Chodnicki, Natalie Wolkow, Michael Yoon, Bart ChwaliszA 30 -year-old pregnant woman without significant medical or ocular history presented with decreased right eye vision. In her 2nd trimester, she was diagnosed with Lyme disease with a bulls-eye rash and positive Lyme antibodies; she was treated with two weeks of amoxicillin. At 33 weeks pregnant she...
41 'X' Marks the SpotLuis Andre Leal Ferman, Leslie Bruch, John Buatti, Jeremy GreenleeThis 24 year-old man presented with several months of progressive visual loss in both eyes. His past medical, surgical and ocular history was unremarkable. There was no family history of phacomatosis. He complained of occasional binocular diplopia, but denied headaches or any other neurological symp...
42 Smoke Gets in Your Eyes (Slides)Tatiana Bakaeva, John Gittinger, Jr.A 61-year-old woman, active smoker with history of COPD, presented with bilateral progressive vision loss and ataxia. Four months prior to her presentation she developed "black spot" in her right eye (OD) and was found to have "OD disc edema and right hypertropia" by an outside ophthalmologist. She ...
43 Smoke Gets in Your Eyes (PDF)Tatiana Bakaeva, John Gittinger, Jr.
44 From Brainstem to Stern (Slides)Neena Cherayil, Angela Viane, Grant Liu, Ali HamedaniA previously healthy 32-year-old man complained of diplopia and one month of worsening positional headaches. He then acutely developed confusion and chills, prompting ER referral. Further history was limited by altered mental status. On presentation, he was afebrile and encephalopathic. Serum WBC wa...
45 You're Too Young for That! (Slides)Sravanthi Vegunta, Kathleen Digre, Bradley Katz, Meagan Seay, Alison Crum, Edward Quigley, Sean Kennedy, Nick Mamalis, Judith WarnerAn 11-year old boy presented with right orbital pain for two months with recent double vision. He had no recent viral illnesses or sick contacts. He had no past medical history. His brother had Kawasaki disease; his paternal grandmother had rheumatoid arthritis; and his father died of a myocardial i...
46 Objects Jumping, Body Bumping, Hearing Slumping…Quick, He is Crumping (Slides)Jorge Kattah, Scott Eggers, Sarah BachA 45 y/o man developed insidious unsteadiness and bilateral hearing impairment. A neurosurgeon diagnosed possible myelopathy, and despite an anterior cervical discectomy, he noted progressive gait difficulty, poor handwriting, and inability to play the guitar. Additionally, dysarthria, oscillopsia a...
47 Close Encounters of the Third Kind (Slides)Trishal Jeeval-Patel, Danny MandellA 65-year old woman started experiencing headaches which increased in severity over two weeks. She eventually sought care in the emergency department. Neurological examination was reported as normal. Unenhanced CT of the brain was performed and reported as normal. Headaches continued and she was pre...
48 Look in the Back (Slides)Tatiana Deveney, Aristides Capizzano, Jonathan TrobeA 59-year old man with Graves disease developed increasing proptosis and diplopia. Attributing these abnormalities to worsening of the Graves disease, an ophthalmologist treated him with high-dose oral and intravenous corticosteroids. When improvement did not occur, he underwent orbital x-irradiatio...
49 Undiscovered Islands - So Close, Yet So Far (PDF)Magdalena Wirth, Farahna Sabiq, Mehdi Agoumi
50 Tumefictive MS (Slides)Anthony J. Brune III, Hemant Parmar, Sandra Camelo-Piragua, Lindsey De Lott
51 Tumefictive MS (PDF)Anthony J. Brune III, Hemant Parmar, Sandra Camelo-Piragua, Lindsey De Lott
52 Bones of the Past (Slides)Bart K. Chwalisz, Konstantinos Douglas, Vivian Douglas, Otto Rapalino
53 Bones of the Past (PDF)Bart K. Chwalisz, Konstantinos Douglas, Vivian Douglas, Otto Rapalino
54 You're Too Young for That! (PDF)Sravanthi Vegunta, Kathleen Digre, Bradley Katz, Meagan Seay, Alison Crum, Edward Quigley, Sean Kennedy, Nick Mamalis, Judith Warner
55 Not All Men with Thick Skulls Have High Testosterone (Slides)Yosbelkys Martin Paez, MD
56 Not All Men with Thick Skulls Have High Testosterone (PDF)Yosbelkys Martin Paez, MD
57 A Myel-In, a Long Way to Go (PDF)Aishwarya Pareek, Timothy Lotze, Gail Demmler, Brandon Tran, William Whitehead, Carrie Mohila, Veeral Shah
58 A Myel-In, a Long Way to Go (Slides)Aishwarya Pareek, Timothy Lotze, Gail Demmler, Brandon Tran, William Whitehead, Carrie Mohila, Veeral Shah
59 A Par 3 Macular Hole? (Slides)Archana Srinivasan, Jerald Gong, Mark Moster
60 Are We "Tilting At Windmills"? (PDF)Michael Vaphiades, DO
61 Well Here Is Another Uveo-Meningeal Syndrome You Might Muck Up (Slides)David DeLeon, Mariel Rojas, Francisco Sanchez, Rosa Tang, Julie Patel, Jade Schiffman
62 Well Here Is Another Uveo-Meningeal Syndrome You Might Muck Up (PDF)David DeLeon, Mariel Rojas, Francisco Sanchez, Rosa Tang, Julie Patel, Jade Schiffman
63 Close Encounters of the Third Kind (PDF)Trishal Jeeval-Patel, Danny Mandell
64 From Brainstem to Stern (PDF)Neena Cherayil, Angela Viane, Grant Liu, Ali Hamedani
65 Look in the Back (PDF)Tatiana Deveney, Aristides Capizzano, Jonathan Trobe
66 Tissue Is the Issue (PDF)Christine Greer, Jasmine Francis, Eli Diamond, Charles Eberhart, Marc Dinkin
67 A Par 3 Macular Hole? (PDF)Archana Srinivasan, Jerald Gong, Mark Moster
68 Oh Oh Oh It's Magic, You Know…Never Believe It's Not So! (PDF)Zeeshan Haq, Jeremy Tanner, Christine Glastonbury, Cathryn Cadwell, Brooks Crawford, Elan Guterman, Maulik Shah, Megan Richie, Nailyn Rasool
69 Oh Oh Oh It's Magic, You Know…Never Believe It's Not So! (Slides)Zeeshan Haq, Jeremy Tanner, Christine Glastonbury, Cathryn Cadwell, Brooks Crawford, Elan Guterman, Maulik Shah, Megan Richie, Nailyn Rasool
70 Objects Jumping, Body Bumping, Hearing Slumping…Quick, He is Crumping (PDF)Jorge Kattah, Scott Eggers, Sarah Bach
71 Are We "Tilting At Windmills"? (Slides)Michael Vaphiades, DOA 52-year-old African American woman presented to her primary care physician with a 4 week history of headaches, nausea, vomiting, fever and ataxia. Her medical history includes rheumatoid arthritis, hypertension and a recent diagnosis of pulmonary; sarcoidosis for which she was taking 20 mg of pred...
72 Undiscovered Islands - So Close, Yet So Far (Slides)Magdalena Wirth, Farahna Sabiq, Mehdi AgoumiA 30-year old female, visiting Canada from India, presented to ophthalmology with a 2-day history of right periorbital swelling, painful proptosis, fevers and chills. Initial examination suggested a clinical diagnosis of post-septal cellulitis with mild motility restriction, without optic nerve comp...
73 Tissue Is the Issue (Slides)Christine Greer, Jasmine Francis, Eli Diamond, Charles Eberhart, Marc Dinkin
74 A Trip Through the WormholeAnne R. Kao, MD
75 A Trip Through the WormholeAnne R. Kao, MD
76 Three's a CrowdKanwal S. Matharu, MD
77 Three's a CrowdKanwal S. Matharu, MD
78 Turbulence, Fluid Waves, and the Black HoleStella Y. Chung, MD, MS
79 A Zebra Among ZebrasPeter Mortensen, Gabrielle Bonhomme
80 Unexplained Becomes ExplainedJinu Han, Hye Young Kim, Sueng-Han Han
81 Fire and IceMary Maher, Joah Aliancy, Gul Moonis, Angela Lignelli, Michael Kazim, Jeffrey Odel
82 Fooled ThriceJonathan A. Micieli, MD, CM
83 Not the Rolling StonesAri A. Shemesh, MD
84 Turbulence, Fluid Waves, and the Black HoleStella Y. Chung, MD, MS
85 A Zebra Among Zebras (Slides)Peter Mortensen, Gabrielle Bonhomme
86 At the CrossroadsKonstantinos Douglas, MD, DVM, MBA
87 Don't Drink the WaterDevon A. Cohen, MD
88 Fire and IceMary Maher, Joah Aliancy, Gul Moonis, Angela Lignelli, Michael Kazim, Jeffrey Odel
89 A-deno What's Going On!Christine Greer, Salina Teja, Jennifer Danesch, Anna Mathew, Vivek Patel, Kimberly Gokoffski
90 Just the Two of UsDan Milea, MD, PhD
91 Every Rose Has Its ThornWilliam J. Anderson, BS
92 Chalky Pallid EdemaDaniel Kornberg, David Pisapia, Cynthia Magro, Cristiano Oliveira, Marc Dinkin
93 The Great MasqueradeBart Chwalisz, Dean Cestari
94 A-deno What's Going On!Christine Greer, Salina Teja, Jennifer Danesch, Anna Mathew, Vivek Patel, Kimberly Gokoffski
95 Go With Your Gut FeelingPaul R. Freund, MD, MSc, FRCSC
96 Don't Drink the WaterDevon A. Cohen, MD
97 Not the Rolling StonesAri A. Shemesh, MD
98 Fooled ThriceJonathan A. Micieli, MD, CM
99 Just the Two of UsDan Milea, MD, PhD
100 Every Rose Has Its ThornWilliam J. Anderson, BS
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