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1 Cavernous Sinus MeningiomaShirley H. Wray, MD, PhD, FRCPThis patient is a 46 year old woman from Portugal who was admitted to the Massachusetts General Hospital in September 1986 with ophthalmoplegia of the left eye (OS) and signs of aberrant reinnervation of the third nerve. She presented, in August 1985, with an episode of diplopia. The diplopia was su...Ptosis; Unilateral Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Paresis of Abduction; Sixth Nerve Palsy; Oculomotor Nerve; Cavernous Sinus Meningioma; Cavernous Sinus Syndrome; Unilateral Oculomotor Third Nerve Palsy; Unilateral Sixth Nerve Palsy
2 Wallenberg Syndrome and Skew DeviationLauren Schneider, MD; Rudrani Banik, MDPower point of case presentation of acute Wallenberg Syndrome associated with vertical diplopia, found by 3 step and supine testing to be consistent with skew deviation.Wallenberg Syndrome; Skew Deviation; Vertical Diplopia
3 Non-Surgical Management of StrabismusAlex Christoff, MDAn overview of non-surgical treatment of strabismus.Strabismus
4 Coughing It Up to Giant Cell ArteritisEthan Zerpa; Stacy V Smith71-year-old with cough, acute monocular diplopia, and bilateral blurred vision lasting eight days. ESR >130 mm/hr. FDG-PET with increased radiotracer activity in the thoracic aorta and branches with hyperintensity extending into the vessels of the neck consistent with giant cell arteritis (GCA). GCA...Cough; Giant Cell Arteritis; Large Vessel Vasculities
5 Bilateral Internuclear OphthalmoplegiaShirley H. Wray, MD, PhD, FRCPThis patient was seen at the Yale Eye Center at the age of 37. She had a long history of multiple sclerosis. At age 22, she had an acute attack of optic neuritis in the left eye which recovered fully within three weeks. Some months later she had a recurrent episode in the same eye, which also recove...Bilateral Internuclear Ophthalmoplegia; Pendular Horizontal Oscillations; Lid Nystagmus; Upbeat Nystagmus; Botulinum Toxin Therapy; Multiple Sclerosis; Horizontal Pendular Nystagmus; Gaze Evoked Upbeat Nystagmus; Abducting Nystagmus
6 Horizontal Gaze PalsyShirley H. Wray, MD, PhD, FRCPThis 56 year old woman with known adenocarcinoma of the breast presented with the recent onset of horizontal diplopia and deviation of her left eye inwards. Her oncologist referred her for a neuro-ophthalmic evaluation. This 56 year old woman with known adenocarcinoma of the breast presented with th...Unilateral Horizontal Gaze Palsy; Esotropia; Fascicular Sixth Nerve Palsy; Horizontal Gaze Evoked Nystagmus; Normal Convergence; Horizontal Oculocephalic Reflexes Absent; Facial Palsy (Bell's Palsy); Abducens Nuclear Lesion; Pontine Metastasis; Adenocarcinoma of the Breast; Unilateral Sixth Nerve Pa...
7 Myxopapillary EpendymomaNagham Al-Zubidi, MDA case of filum terminale tumor presented with symptoms and sign of idiopathic intracranial hypertension.Myxopapillary Ependymoma; Idiopathic Intracranial Hypertension; Filum Terminale Tumor
8 Decompensated PhoriaAlex Christoff, MDAn overview of decompensated phoria and its treatment.Decompensated Phoria
9 Chest CT Thymoma (Guest Lecture)Robert A. Novelline, MDThe 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 intern...Unilateral Ptosis; Unilateral Lid Retraction; Myasthenic Lid Twitch; External Ophthalmoplegia; Ocular Myasthenia Gravis; Tensilon Test; Thymolipoma; Generalized Myasthenia Gravis; Unilateral Myasthenia Gravis; Myasthenic Ptosis; Lid Retraction; Lid Twitch
10 Multiple Myeloma (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 48-year-old female was seen in May 1996 with a history of 2 months of diplopia from a right abducens palsy. This was due to the recurrence of myeloma that had initially been diagnosed and treated with radiation and chemotherapy 9 years before and required further therapy, including bone marrow ...Multiple Myeloma
11 Carotid Cavernous Fistulas (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 76-year-old woman has a 7-month history of redness and pressure sensation in both eyes that is worse in the morning. She has noted intermittent horizontal diplopia during this time. Angiography demonstrated a right dural cavernous sinus fistula, which was successfully occluded with direct injec...Dural Arteriovenous Malformation; Carotid Cavernous Fistulas
12 Tadpole Pupil (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyIntermittent dilation of the pupils may occur as a benign phenomenon in healthy young adults. In the absence of other third nerve signs, (eg, ptosis, diplopia, ophthalmoplegia), an isolated transient dilation of the pupil in an otherwise healthy adult is unlikely to represent a third nerve palsy. Tr...Tadpole Pupil
13 Myasthenia Gravis (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThe 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 intern...Unilateral Ptosis; Unilateral Lid Retraction; Myasthenic Lid Twitch; External Ophthalmoplegia; Ocular Myasthenia Gravis; Tensilon Test; Thymolipoma; Generalized Myasthenia Gravis; Unilateral Myasthenia Gravis; Myasthenic Ptosis; Lid Retraction; Lid Twitch
14 Myasthenia ThymomaShirley H. Wray, MD, PhD, FRCPThe 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 intern...Unilateral Ptosis; Unilateral Lid Retraction; Myasthenic Lid Twitch; External Ophthalmoplegia; Ocular Myasthenia Gravis; Tensilon Test; Thymolipoma; Generalized Myasthenia Gravis; Unilateral Myasthenia Gravis; Myasthenic Ptosis; Lid Retraction; Lid Twitch
15 Pituitary Apoplexy and Hemifield Slide PhenomenonHelen H. Yeung, MD; Rudrani Banik, MDPowerPoint of case presentation of pituitary apoplexy. Patient presented with bilateral severe visual loss and bilateral ophthalmoplegia from partial third nerve palsies (pupil-sparing with no ptosis) from midbrain compression. After transsphenoidal surgery with decompression of mass and steroids, ...Pituitary Apoplexy; Hemifield Slide; Bitemporal Defect; Partial Third Nerve Palsy
16 CNS LymphomaShirley H. Wray, MD, PhD, FRCPThe patient is a 70 year old Italian man with atrial fibrillation on long-term coumadin therapy. In October 1995, he developed generalized headache, horizontal double vision and his left eye deviated inwards (esotropia). A diagnosis of left sixth nerve palsy was made and attributed to microvascular ...Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS Non-Hodgkin's Lymphoma; Cavernous Sinus Syndrome; Lymphoma
17 Brown SyndromeMeagan Seay, DOA brief overview of Brown Syndrome.Brown Syndrome
18 Convergence InsufficiencyShirley H. Wray, MD, PhD, FRCPThe patient is a 73 year old man with a ten year history of idiopathic Parkinson's disease characterized by difficulty in walking, generalized rigidity and a mild tremor of his hands at rest with deterioration in his handwriting. He denied any memory impairment or loss of cognitive function. He was ...Basal Ganglia; Blepharoclonus; Convergence Insufficiency; Slow Hypometric Saccades; Saccadic Breakdown of Smooth Pursuit; Parkinson's Disease- Dopamine deficiency; Slow Hypometric Horizontal Saccades; Convergence
19 Superior Ophthalmic Vein Thrombosis (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 27-year-old woman had no past ocular history and presented with 3 weeks of redness OS that has been treated by the referring doctor as allergic conjunctivitis. She was referred for evaluation when she developed binocular diplopia. Her past medical history included phlebitis and one miscarriage ...Superior Ophthalmic Vein Thrombosis
20 Clival Menigioma Causing 6th Nerve PalsyBashaer Aldhahwani, MD; Mariam S. Vilá-Delgado, MD65 year- old Male patient presented with progressive binocular, horizontal diplopia with limitation of abduction in the right eye. He was diagnosed with Isolated compressive right 6th CN palsy due to right Clival Meningioma.Clival Meningioma; Sixth Nerve Palsy
21 Heavy Eye SyndromeMeagan D. Seay, DO; Bradley J. Katz, MDA brief overview of heavy eye syndrome.Heavy Eye Syndrome
22 Non-Organic Visual LossOmar Ozgur, MD; Rudrani Banik, MDPower point of case presentation of 12 year old girl with recurrent monocular visual loss. Examination is normal. Differential diagnosis discussed, including non-organic visual loss. Diagnostic testing for non-organic visual loss reviewed. Slide 4: Figure 1: Table of exam findings Slide 5: Figure 2...Non-organic Visual Loss; Monocular Visual Loss
23 Parasellar MeningiomaShirley H. Wray, MD, PhD, FRCPThis 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 look...Ptosis; Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Oculomotor Nerve; Parasellar Meningioma; Cavernous Sinus Syndrome; Unilateral Oculomotor Third Nerve Palsy; Unilateral Third Nerve Palsy
24 Supranuclear Paralysis of Vertical GazeShirley H. Wray, MD, PhD, FRCPThis case was presented to the Clinical Eye Movement Society at the American Neurological Association Meeting in October 2007. The patient is a healthy, 36 year old Lieutenant Commander in the Coast Guard who was last seen perfectly well at 2 a.m. on the day of admission. He awoke in the morning aro...Somnolence; Global Supranuclear Paralysis of Vertical Gaze; Absent Vertical Saccades and Pursuit Movements; Intact Convergence; Convergence Retraction Nystagmus; Ocular Dysmetria; Ocular Tilt Reaction; Lateropulsion; Unilateral Midbrain and Thalamic Infarct; Supranuclear Paralysis of Up and Downgaze...
25 High Yield Secondary HeadachesKathleen B. DigreLecture and case reports relating to secondary headaches.Primary Headache; Secondary Headache
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