Videos, clinical notes and related presentations concerning neuro-ophthalmological and neurovisual disorders collected during Dr. Wray's work as the Director of Neuro-Visual Disorders at Massachusetts General Hospital.
Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General Hospital.
NOVEL: https://novel.utah.edu/
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| Identifier | Title | History | Subject | ||
|---|---|---|---|---|---|
| 1 |
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003-2 | Palatal Tremor | This patient presented with an acute brainstem stroke with: 1. A unilateral lower motor neuron (LMN) facial palsy on the right 2. A horizontal gaze palsy to the right 3. Mild unsteadiness walking The infarct localized clinically to the right side of the pons involving the abducens nucleus and the g... | Palatal Tremor (Myoclonus); Pendular Vertical Oscillations; Unilateral Horizontal Gaze Palsy; Facial Palsy; Pontine Infarct; Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillain-Mollaret Triangle; Oculopalatal Myoclonus; Oculopalatal Tremor |
| 2 |
 |
003-3 | Downbeat Nystagmus | This patient carries a diagnosis of Type I Chiari malformation. Neurological symptoms of a Chiari malformation may not develop until adolescence or adult life as in this man. The symptoms may be those of: 1. Increased intracranial pressure, mainly headache 2. Progressive cerebellar ataxia 3. Progre... | Downbeat Nystagmus; Lid Nystagmus; Oscillopsia; Chiari-1 Malformation; Primary Position Downbeat Nystagmus; Chiari Malformation |
| 3 |
 |
004-1 | Ocular Dipping | The patient is a 32 year old woman with juvenile diabetes mellitus. She collapsed at home and was rushed to the emergency room where a diagnosis of a locked-in syndrome was made. The term Locked-in Syndrome (LiS) was coined in 1966 by Plum and Posner for a condition with the following criteria: 1.... | Ocular Dipping; Bilateral Horizontal Gaze Palsy; Full Vertical Gaze; Locked In Syndrome; Embolic Basilar Artery Occlusion; Bilateral Pontine Infarction; Pontine Infarct; Comatose Patient |
| 4 |
 |
004-3 | Lid Lag | The classical eye signs of thyroid associated ophthalmopathy (TAO) of Graves' Disease is illustrated by case ID925-4. This 50 year old woman with TAO is included in the collection because she illustrates very well lid lag (persistent elevation of the upper eyelid in downgaze) - von Graefe sign E... | Lid Lag; Bilateral Exophthalmos; Restrictive Orbitopathy of Graves' Disease |
| 5 |
 |
005-1 | Third Nerve Palsy | This 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... | 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 |
| 6 |
 |
010-1 | Palinopsia | The patient is a healthy 59 year old woman who presented in 1978 with transiet visual symptoms. The first visual disturbance occurred in December 1978 when suddenly she noted: • Fluttering of vision in the left eye (OS) • The appearance of a central black spot • Around the edge of the blac... | Palinopsia; Prosopometamorphopsia; Migraine Visual Aura with Headache; Falx Meningioma; Occipital Lobe; Visual Phenomena |
| 7 |
 |
016-1 | Retinal Emboli | Temporary loss of vision in one eye, termed transient monocular blindness (TMB), is the most important visual symptom of arteriosclerotic vascular disease, arteritis and states of altered coagulability and thrombocytosis. In most patients, the visual disturbance during each individual attack of ... | Retinal Emboli; Transient Monocular Blindness; Ocular Stroke; Transient; Transient Visual Loss |
| 8 |
 |
026-1 | Sixth Nerve Palsy | The patient is a 45 year old pharmaceutical executive who, nine days prior to admission, flew back from San Francisco after a hectic business trip feeling jet lagged and fatigued. Inspite of this, four days later, he did a day trip to New York. On the following morning, a Saturday, he awoke with ... | Sixth Nerve Palsy; Esotropia; Gradenigo's Syndrome; Unilateral Sixth Nerve Palsy; Sixth (Abducens) |
| 9 |
 |
040-1 | MS Time Lapse MRI | Professor Ian McDonald, Institute of Neurology, Queen Square, London contributed this remarkable Time-Lapse MRI of focal MS lesions in a single patient with multiple sclerosis over a period of one year. This time lapse video was assembled from serial T2- weighted MRI scans from a 25-year old wo... | Multiple Sclerosis; Serial Brain MRI in Multiple Sclerosis |
| 10 |
 |
041-1 | Migraine / PET Study | In December 1994 the New England Journal of Medicine published a remarkable paper Bilateral Spreading Cerebral Hypoperfusion during Spontaneous Migraine Headache. Roger P. Woods, Marco Iacoboni and John C. Mazziotta. which is reproduced in part, and accompanied by a video illustration. Courtesy of J... | Migraine Headache; Regional Cerebral Blood Flow; Migraine Visual Aura |
| 11 |
 |
042-1 | Oculomasticatory Myorhythmia | This case, previously reported in 1986, is published courtesy of John Selhorst, M.D., Saint Louis University School of Medicine, St. Louis, MO. (4) The patient is a 46 year old man who, over a period of six months, lost the ability to read and complained of excessive somnolence, occasional urinary i... | Somnolence; Supranuclear Paralysis of Up and Downgaze; Pendular Vergence Oscillations; Oculomasticatory Myorhythmia; Tropheryma Whippelii - Infection; CNS Whipple's Disease; Supranuclear Paralysis of Up and Downgaze Infection - Whipple's Disease; Oculomasticatory Myorhythmia (Whipple's) |
| 12 |
 |
161-1 | Jaw Winking | This young boy was born at full term after a normal pregnancy with congenital unilateral ptosis of the left eyelid. His mother noticed that when he was sucking on a bottle the ptotic eyelid opened and closed. A diagnosis of the Marcus-Gunn jaw winking phenomenon was made. The first case of thi... | Congenital Unilateral Ptosis; Jaw Winking; Lid Winking; Trigemino-oculomotor Synkinesis; Marcus-Gunn Jaw Winking Phenomenon; Congenital Ptosis; Marcus Gunn Jaw Wink |
| 13 |
 |
161-19 | Hemifacial Spasm: Eyelid Twitching | This patient is an atypical case of hemifacial spasm because he is a young college student only 29 years of age. Hemifacial spasm usually develops in the fifth and sixth decade of life and affects women more than men. It often begins insidiously in the orbicularis oculi muscle in the early stage... | Lid Twitch; Hemifacial Spasm; Neurovascular Compression Syndrome of the Facial Nerve |
| 14 |
 |
161-21 | Lateropulsion | This 44 year old woman has a diagnosis of Multiple Sclerosis. | |
| 15 |
 |
161-5 | Benign Essential Blepharospasm | Patient is a 55 year old woman functionally blind from severe benign essential blepharospasm. She presented with frequent blinking.continuous spasms of eye closure and great difficulty opening her eyes i.e. blepharospasm associated "apraxia of eyelid opening". Symptomatic Inquiry negative for... | Benign Essential Blepharospasm; Focal Dystonia; Blepharospasm |
| 16 |
 |
162-2 | Congenital Ocular Motor Apraxia | This little boy was born at term after a normal pregnancy. There was no family history of a neurological or ophthalmological disease. His mother noted from birth that he turned his head instead of his eyes and frequently tried to fix objects on either side by making a quick turn of the head past... | Congenital Ocular Motor Apraxia; Head Thrust |
| 17 |
 |
162-3 | Congenital Ocular Motor Apraxia | This baby was born at term after an uneventful pregnancy and normal delivery. He was the first and only child. There was no family history of any This baby was born at term after an uneventful pregnancy and normal delivery. He was the first and only child. There was no family history of any neurol... | Congenital Ocular Motor Apraxia; Head Thrust |
| 18 |
 |
162-4 | Ocular Flutter | This little boy complained of difficulty focusing. On examination he was found to have ocular flutter. He was otherwise neurologically intact and in good general health. Investigations were directed to rule out 1. Neuroblastoma (see ID 936-8) 2. Enterovirus infection 3. Parainfect... | Idiopathic Ocular Flutter |
| 19 |
 |
162-5 | Congenital Ocular Motor Apraxia | This 3 year old boy was referred for evaluation of inattention. He was born at term after a normal pregnancy. He had been noted, in early childhood, to have difficulty looking to the right and to the left and was slow to read. | Congenital Ocular Motor Apraxia; Head Thrust |
| 20 |
 |
162-6 | Ocular Motor Apraxia | This elderly patient was referred to the Movement Disorder Clinic for evaluation of abnormal head thrust movements when asked to look on command to the right or to the left. His random eye movements were full vertically and horizontally. Diagnosis: Acquired Ocular Motor Apraxia ... | Acquired Ocular Motor Apraxia; CNS Degenerative Disease; Head Thrust; Frontotemporal Dementia; Ocular Motor Apraxia |
| 21 |
 |
162-7 | Congenital Horizontal Gaze Palsy | The patient is an 8 year old boy with a rare autosomal recessive disorder characterized by congenital absence of conjugate horizontal eye movements preservation of vertical gaze and convergence and progressive scoliosis (HGPPS) developing in childhood. The child was referred to Dr. Cogan with a ... | Congenital Horizontal Gaze Palsy; Progressive Scoliosis; Mutation of the ROBO 3 Gene on Chromosome 11q23-q25; Congenital Cranial Disinnervation Syndrome; Mobius Syndrome |
| 22 |
 |
162-8 | Supranuclear Paralysis of Upgaze | This young child presented with headache and unsteadiness. He was found to have obstructive hydrocephalus, aqueduct stenosis and a medulloblastoma. The constellation of clinical eye signs localized to the Dorsal Midbrain and included: • Supranuclear paralysis of upgaze (saccadic and pursuit move... | Supranuclear Paralysis of Upgaze; Convergence Retraction Nystagmus; Eyelid Retraction - Collier's Sign; Normal Downgaze; Esotropia; Sixth Nerve Palsy; Dorsal Midbrain Syndrome; Obstructive Hydrocephalus; Aqueduct Stenosis; Medulloblastoma; Increased Intracranial Pressure; Unilateral Sixth Nerve Pals... |
| 23 |
 |
163-1 | Unilateral Ptosis | The 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 in... | Unilateral Ptosis; Unilateral Lid Retraction; Myasthenic Lid Twitch; External Ophthalmoplegia; Ocular Myasthenia Gravis; Tensilon Test; Thymolipoma; Generalized Myasthenia Gravis; Unilateral Myasthenia Gravis; Ptosis -- Myasthenic; Lid Retraction; Lid Twitch |
| 24 |
 |
163-10 | Bilateral Ptosis | The patient is a 65 year old physician who presented with intermittent drooping of his eyelids, particularly at the end of the day. He found that if he gently closed his eyes when he came to a stop in his car at a set of traffic lights, his eyelids opened more fully. He subsequently developed inte... | Bilateral Ptosis; Decompensated Phoria; Myasthenic Lid Twitch; Tensilon Test; Bilateral Myasthenia Gravis; Ocular Myasthenia Gravis; Ptosis - Myasthenic |
| 25 |
 |
163-11 | Pseudo-Internuclear Ophthalmoplegia | In 1969 this 54 year old man presented with a one month history of blurry vision which started suddenly one afternoon. He said he was "just not focusing" and he saw two images when he "relaxed his sight". He could see clearly covering one eye. Initially, the difficulty in focusing occurred la... | Pseudo-Internuclear Ophthalmoplegia; Bilateral Weakness of Adduction; Tensilon Test; Ocular Myasthenia Gravis; Bilateral Myasthenia Gravis |