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 | ||
|---|---|---|---|---|---|
| 76 |
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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 |
| 77 |
 |
166-3 | Neonatal Opsoclonus | This child was one of the first cases of opsoclonus that I saw with Dr. Cogan in the early 1970's. The baby is a unique case in that in addition to neonatal opsoclonus with the characteristic multidirectional conjugate back-to-back saccades, periods of large amplitude upbeat nystagmus also occurred.... | Neonatal Opsoclonus; Upbeat Nystagmus; Lid Nystagmus; Saccadic Oscillations |
| 78 |
 |
166-4 | Neonatal Opsoclonus | This child was one of the first cases of opsoclonus that I saw with Dr. Cogan in the early 1970's. He carried a diagnosis of strabismus with deviation of the left eye. In this child, opsoclonus occurred as a transient phenomenon in an otherwise healthy infant. For a complete overview of opsoclonus i... | Neonatal Opsoclonus; Lid Nystagmus; Saccadic Oscillations |
| 79 |
 |
910-2 | Normal Eye Movements | The video of the normal eye movement examination was made with the assistance of Dr. Terrence Millette, a neurologist and former Fellow with me in 1985-1986. Introduction to the Saccadic System Saccades are fast eye movements that bring the image of an object of interest onto the fovea. They c... | "Normal Eye Movements; Examination, Ocular; Saccades; Optokinetic Nystagmus Drum (OKN Drum); Pursuit; Ocular Motility" |
| 80 |
 |
163-21 | Nuclear Third Nerve Palsy | The 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... | Nuclear Third Nerve Palsy; Bilateral Ptosis; Bilateral Superior Rectus Palsy; Normal Pupils; Midbrain Infarct; Oculomotor Nerve; Nuclear; Thalamic Infarct |
| 81 |
 |
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 |
| 82 |
 |
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 |
| 83 |
 |
166-2 | Ocular Flutter | This patient was seen in the Neurovisual Clinic for evaluation of a monocular attack of optic neuritis which completely resolved. Six months later, she became unsteady walking and was found to have bilateral ataxia. She was given a diagnosis of multiple sclerosis (MS). Neuro-ophthalmological examin... | Ocular Flutter; Multiple Sclerosis; Lid Flutter; Multiple Sclerosis Ocular Flutter |
| 84 |
 |
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 |
| 85 |
 |
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) |
| 86 |
 |
166-12 | Opsoclonus in The Dark | N/A | Saccadic Oscillations; Paraneoplastic Opsoclonus; Oscillopsia; Opsoclonus; Saccadomania |
| 87 |
 |
927-1 | Palatal Tremor | The patient is a 60 year old woman with insulin dependent diabetes mellitus. She was legally blind as a result of diabetic retinopathy and bilateral vitreous hemorrhage. In 1987, she was admitted to her local hospital with slurred speech and a right hemiparesis progressing over a period of three d... | Pendular Vertical Oscillations; Palatal Tremor (Myoclonus); Brainstem Infarct; Unilateral Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillain - Mollaret Triangle; Pontine Infarct |
| 88 |
 |
936-4 | Palatal Tremor | The patient is a 44 year old left handed man with a history of IV drug abuse (heroin and cocaine) alcoholism, hypertension, and rheumatic fever. In March 1990, at 3 a.m. on the day of admission, he had acute onset of dizziness, slurred speech, left sided weakness and difficulty walking. He was ... | Pendular Vertical Oscillations; Lid Nystagmus; Bilateral Horizontal Gaze Palsy; Palatal Tremor (Myoclonus); Pontine Hemorrhage; Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillain - Mollaret Triangle; Bilateral Horizontal Gaze Palsy Hemorrhage; Facial Weakness; Speech La... |
| 89 |
 |
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 |
| 90 |
 |
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 |
| 91 |
 |
166-6 | Parainfectious Opsoclonus | This child was one of a group of children with opsoclonus that I saw with Dr. Cogan in the early 1970's. This boy carries the diagnosis of parainfectious brainstem encephalitis. In the absence of myoclonus, myoclonic encephalopathy often referred to as dancing eyes and dancing feet was ruled out. ... | Parainfectious Opsoclonus; Saccadic Oscillations |
| 92 |
 |
945-1 | Paralysis of Convergence | The patient is a 25 year old man with a long history of headaches due to hydrocephalus. He carries the following diagnoses: 1. Hydrocephalus 2. Aqueduct stenosis 3. Low grade glioma involving the quadrageminal plate 4. Seizures The patient first came to neurological attention at the age of 12 whe... | Supranuclear Upgaze Palsy; Convergence Insufficiency; Horizontal Gaze Evoked Rotary Nystagmus; Hydrocephalus; Seizures; Brainstem Glioma |
| 93 |
 |
936-7 | Paraneoplastic Ocular Flutter | The patient is a 58 year old woman with known hypertension. In 1994, two weeks prior to admission she had a dramatic change in behavior with insomnia, agitation and depression. This was accompanied by "ringing of hands and anxiety for no apparent reason". She became anorexic, lost 15 pounds ... | Ocular Flutter; Oscillopsia; Trunkal Ataxia; Paraneoplastic Cerebellar Syndrome; Small Cell Carcinoma of the Lung; Paraneoplastic Ocular Flutter; Flutter |
| 94 |
 |
931-1 | Paraneoplastic Opsoclonus | This patient is the index case of the Anti-Ri antibody, published in Annals of Neurology in 1988 (4). The Anti-Ri antibody is recognized to be a paraneoplastic marker in patients with breast and gynecological malignancies (10). The history of this case is particularly important because she was in... | Opsoclonus; Ocular Flutter; Oscillopsia; Saccadic Oscillations; Paraneoplastic Cerebellar Syndrome; Adenocarcinoma of the Breast; Anti-Ri Antibody; Paraneoplastic Opsoclonus; Paraneoplastic Ocular Flutter; Saccadomania |
| 95 |
 |
166-1 | Paraneoplastic Opsoclonus/Flutter | In 1975 this patient presented with oscillopsia due to opsoclonus with ocular flutter. Opsoclonus with flutter is a paraneoplastic syndrome associated with occult cancer of the breast, ovary and lung. This patient had cancer of the breast. In 1954 Cogan first used the term "ocular flutter" to d... | Opsoclonus; Ocular Flutter; Paraneoplastic Cerebellar Syndrome; Adenocarcinoma of the Breast; Paraneoplastic Opsoclonus; Paraneoplastic Ocular Flutter |
| 96 |
 |
936-8 | Paraneoplastic Opsoclonus; Downbeat Nystagmus | The patient is Case 27-1995 Case Records of the Massachusetts General Hospital (New Eng. J Medicine 1995, 333:579-586). The discusser was Dr. Elizabeth Engle, Associate Professor of Neurology, Harvard Medical School. The baby girl was born after a 30 week gestation, with a birth weight of 1.25 k... | Downbeat Nystagmus; Paraneoplastic Opsoclonus; Neuroblastoma; Primary Position Downbeat Nystagmus; Ataxia; Paraneoplastic Downbeat Nystagmus |
| 97 |
 |
212-3 | Paraneoplastic Upbeat Nystagmus | This case was presented to the Clinical Eye Movement Society at the American Neurological Association Meeting in October 2009. The patient is a 65 year old woman who was in good health until seven weeks prior to admission. On June 22/09 on the return flight from her daughter's wedding in Oregon she ... | Upbeat Nystagmus; Lid Nystagmus; Square Wave Jerks (Saccadic Oscillations); Saccadic Dysmetria; Saccadic Pursuit; Paraneoplastic Syndrome; Paraneoplastic Upbeat Nystagmus; Pancreatic Endocrine Carcinoma; Anti-Hu - Associated Paraneoplastic Encephalitis |
| 98 |
 |
169-37 | Paroxysmal Skew Deviation | In 1970 I saw this unique case with Dr. Cogan. The patient is a 60 year old hypertensive woman with a ten year history of intermittent vertical double vision and oscillopsia. Neurological examination between attacks of diplopia showed: Visual acuity 20/25 OU Visual fields, pupils and fundus exami... | Paroxysmal Skew Deviation; Ocular Tilt Reaction; Otolith-Ocular Pathway; Skew Deviation |
| 99 |
 |
941-3 | Pendular Horizontal Oscillations | This 37 year old woman has had progressive multiple sclerosis (MS) affecting the cerebellum and brainstem for 6 years. Neurological examination: Titubation Dysarthria Incoordination of the extremities Ataxic gait Spastic paraparesis with generalized hyperreflexia and extensor plantar responses. ... | Pendular Horizontal Oscillations; Left Beating Nystagmus; Obtrusive Saccades; Bilateral Gaze Evoked Nystagmus; Saccadic Dysmetria; Oscillopsia; Titubation; Ataxia; Multiple Sclerosis; Primary Position Horizontal Nystagmus; Gaze Evoked Horizontal Nystagmus; Horizontal Saccadic Dysmetria |
| 100 |
 |
946-8 | Pendular Nystagmus; Horizontal Gaze Palsy | The patient is a 29 year old retarded man with a rare autosomal recessive disorder characterized by congenital absence of conjugate horizontal eye movements, preservation of vertical gaze and convergence and horizontal pendular nystagmus. Ocular motility examination: Conjugate horizontal pendular n... | Horizontal Pendular Nystagmus; Congenital Horizontal Gaze Palsy; Preservation of Convergence; Normal Vertical Gaze; Optokinetic Nystagmus Absent; Horizontal Vestibular Ocular Reflex Absent; Mutation of the ROBO 3 Gene on Chromosome 11q23-q25; Congenital Cranial Disinnervation Syndrome |