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1 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. ...
2 Frizzle FrazzledEric 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...
3 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...
4 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, ...
5 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...
6 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...
7 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...
8 '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...
9 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...
10 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...
11 A Myel-In, a Long Way to Go (Video)Aishwarya Pareek, Timothy Lotze, Gail Demmler, Brandon Tran, William Whitehead, Carrie Mohila, Veeral ShahA 9-year-old previously healthy female with two recent admissions for presumed diagnosis of ADEM re-presented with persistent headache and ataxic gait. During her initial admissions, she presented with fever, acute onset of ataxia, facial asymmetry and abnormal eye movements. Inpatient ocular exam s...
12 Well Here Is Another Uveo-Meningeal Syndrome You Might Muck Up (Video)David DeLeon, Mariel Rojas, Francisco Sanchez, Rosa Tang, Julie Patel, Jade SchiffmanA 16 y/o Caucasian female with a BMI of 24, went for an eye exam for blurry vision which corrected with refraction, however bilateral disc edema was found. There was a 4-year history of headaches that were intermittent and escalating in nature around 5 days a week, about 1 hour after awakening, and ...
13 From Brainstem to Stern (Video)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...
14 Close Encounters of the Third Kind (Video)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...
15 Look in the Back (Video)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...
16 Tissue Is the Issue (Video)Christine Greer, Jasmine Francis, Eli Diamond, Charles Eberhart, Marc DinkinA 34-year-old man with a past medical history of bilateral corneoscleral lesions and brainstem, thalamic, and temporal lobe lesions presented with progressive vision loss over seven months. He described graying out of vision with light sensitivity. Bilateral, retrobulbar, deep ocular pain started 2 ...
17 A Par 3 Macular Hole? (Video)Archana Srinivasan, Jerald Gong, Mark MosterA 78-year old woman with 3-week history of sudden onset "visual blur" OU and difficulty reading was evaluated by her ophthalmologist and suspected to have macular hole secondary to posterior vitreous detachment and vitreomacular traction (VMT). Her past medical history was significant for hypertensi...
18 Are We "Tilting At Windmills"? (Video)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...
19 Oh Oh Oh It's Magic, You Know…Never Believe It's Not So! (Video)Zeeshan Haq, Jeremy Tanner, Christine Glastonbury, Cathryn Cadwell, Brooks Crawford, Elan Guterman, Maulik Shah, Megan Richie, Nailyn RasoolA 72-year-old man with chronic sinusitis, obstructive sleep apnea, and recent extensive travel presented with right-sided headaches, vision changes, and allergy symptoms. A head CT demonstrated a sinus infection and he was treated with amoxicillin-clavulanate; and prednisone. His headache persisted ...
20 Objects Jumping, Body Bumping, Hearing Slumping…Quick, He is Crumping (Video)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...
21 Undiscovered Islands - So Close, Yet So Far (Video)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...
22 Tumefictive MS (Video)Anthony Brune III, Hemant Parmar, Sandra Camelo-Piragua, Lindsey De LottA 26-year-old woman with history of diabetes insipidus and hypothyroidism presented for evaluation of painless vision loss in her right eye. She was evaluated by a local neurologist and multiple sclerosis (MS) specialist who diagnosed acute optic neuritis. MRI brain showed an enhancing T2 hyperinten...
23 Bones of the Past (Video)Bart Chwalisz, Konstantinos Douglas, Vivian Douglas, Otto RapalinoA 44-year-old woman presented with two episodes of binocular horizontal diplopia within one year. She had a history of Cushing's syndrome status post transsphenoidal resection and bilateral adrenalectomy 4 years prior, hypertension, and secondary diabetes mellitus. Nine months prior she developed se...
24 You're Too Young for That! (Video)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...
25 Smoke Gets in Your Eyes (Video)Tatiana Bakaeva, John Gittinger, JrA 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 ...
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