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1 Bilateral PtosisPatient is a 65 year old woman who presented with acute onset of bilateral ptosis. She awoke one day and found her eyelids half shut and she was unable to see. The lids completely shut and she came to the Massachusetts General Hospital Emergency Room and was admitted. Past History: Negative for pt...Image/MovingImage
2 Third Nerve Palsy; Aberrant ReinnervationThe patient is a 48 year old man from Saudi Arabia who came to the Massachusetts General Hospital for a second opinion and hopefully for surgical correction of ptosis of the left eye (OS). He had a long standing left third nerve palsy due to compression of the nerve trunk by a cavernous sinus mening...Image/MovingImage
3 Nuclear Third Nerve PalsyThe following case is the first patient I saw with a nuclear third nerve palsy. The patient is a 52 year old man with hypertension and hyperlipidemia. He awoke one morning unable to open his eyes. To walk he tilted his head backwards and looked down. He came to the emergency room of the Massach...Image/MovingImage
4 Third Nerve PalsyThe patient is an 85 year old man with hypertension and Type II diabetes mellitus. He presented with a ten day history of drooping of the left eye, unaccompanied by eye pain or headache. With the lid elevated he had double vision in all directions of gaze. He came to the Massachusetts General Ho...Image/MovingImage
5 Third Nerve PalsyThis 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...Image/MovingImage
6 Third Nerve PalsyThis 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 s...Image/MovingImage
7 Fascicular Third Nerve PalsyThe patient is a 76 year old woman who woke one morning unable to see out of her right eye because of ptosis. She came to the Massachusetts General Hospital emergency room and was admitted. Neurological Examination: Right third nerve palsy involving the pupil Ataxia of the left hand on finger-nose t...Image/MovingImage
8 Third Nerve PalsyThe patient is a 57 year old man who carried a diagnosis of atrial fibrillation and coronary artery disease post CABAG. He was seen in the Massachusetts General Hospital ER with acute double vision and headache and was admitted. Four days prior to admission (PTA) he developed a bifrontal headach...Image/MovingImage
9 Third Nerve PalsyThe patient is a 50 year old man with Type II Diabetes who presented to an outside hospital in September 1996 with ptosis and an inability to open the right eye. Five months prior to admission (PTA), he had flu-like symptoms with mild fever, sinus congestion and diffuse myalgia in the chest, abdo...Image/MovingImage
10 Supranuclear Paralysis of UpgazeThe patient is a 58 year old man who was admitted as an emergency with hypersomnolence, gait ataxia and diplopia. On the night before Thanksgiving he went to bed feeling well. He was awoken by a phone call at 2 p.m. on Thanksgiving day having over slept by 7 hours. He got out of bed to answer th...Image/MovingImage
11 Supranuclear Paralysis of DowngazeThe patient is a 64 year old man with no major past medical history who, on the day of admission, suddenly developed loss of vision in both eyes and then was unable to open his eyes on his own unless he used his hands. Holding his eyelids open his vision was very blurry. Within minutes he lost con...Image/MovingImage
12 Sixth Nerve PalsyThis 46 year old patient had at age 6, a tendency for the left eye to wander out. Her face photograph at that age shows an exotropia and at age 7, a year later, the exotropia was not quite as prominent. It was assumed that the exotropia was due to a non-paralytic strabismus. Past History: ...Image/MovingImage
13 Supranuclear Paralysis of UpgazeThis 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...Image/MovingImage
14 Fourth Nerve PalsyThe patient is a 32 year old, left handed chemistry teacher who presented with intermittent vertical double vision. In August 1992 she noted, particularly late in the evening when reading in bed, vertical double vision. The images were one on top of the other and on occasions one image was slig...Image/MovingImage
15 Bilateral Internuclear OphthalmoplegiaThis 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 ...Image/MovingImage
16 Fisher's One and a Half SyndromeThe patient is a 56 year old woman who was seen by a Stroke Consult on the cardiac unit because she had difficulty opening her left eye and diplopia looking to the right. On examination she had ptosis OS and "a partial ophthalmoplegia" sparing the pupil. Diagnosis Partial left third nerve palsy....Image/MovingImage
17 Apraxia of Eyelid OpeningIn January 1997, This 73 year old patient was referred to the Neurovisual Clinic. At that time his speech was slurred and he stated that his eyes were his "biggest" complaint due to: 1. Impaired focusing "close up" 2. His eyes shut spontaneously much of the time 3. Bright sunlight provoked eye ...Image/MovingImage
18 Supranuclear Paralysis of DowngazeJohn Trojanowski and I published this case in Neurology in 1980.(12) At that time, it was one of the first of five reports in the literature of the pathological localization of lesions in the midbrain that are responsible for selective supranuclear paralysis of downgaze. This case is of particula...Image/MovingImage
19 Upbeat NystagmusThe patient is a 31 year old woman with a past history of morbid obesity treated in 2005 by gastric bypass with a weight change from 270 pounds to 170 pounds. In January 2008, she was admitted as an emergency to an outside hospital complaining of pressure headache with photophobia and phonophobia, n...Image/MovingImage
20 Supranuclear Paralysis of UpgazeThe patient is a 37 year old man with a history of intravenous drug abuse, AIDS, and tuberculosis. He presented with a chief complaint of unsteadiness walking for two weeks and vertical diplopia for four days. Past History: Human immunodeficiency Virus (HIV) positive When his CD4 lymphocyte count b...Image/MovingImage
21 Supranuclear Paralysis of UpgazeThe patient is a 32 year old man who was admitted as an emergency with severe headache and papilledema. On examination he had signs of the Pretectal Syndrome. • Bilateral lid retraction in primary gaze - Collier's sign • Supranuclear paralysis of upgaze (saccades and pursuit) • Full horizon...Image/MovingImage
22 Supranuclear Paralysis of UpgazeThe patient is a 33 year old man who called the police to his apartment at 3 a.m. on the morning of admission. They found his apartment in a state of disarray and realized that he had been down on the floor for some hours and only just able to open the door to let them in. He was admitted to the l...Image/MovingImage
23 Supranuclear Paralysis of UpgazeThe patient is a 71 year old woman who was admitted to the Cardiac Unit following an acute "rush to the head", diaphoresis, and palpitations. She felt she was about to faint. She described seeing gold rings in her vision for a few minutes. Past History: Partial complex seizures since 1987. Th...Image/MovingImage
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