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1 Direct carotid-cavernous sinus fistulaA 40-year-old man presented with decreased vision and redness in his left eye. He had a significant trauma to the left side of his face about one year ago, but did not seek medical attention. External examination showed significant proptosis of the left eye (Figure 1) and conjunctival injection and ...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine, Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
2 Enophthalmos from breast cancer metastasis to the orbitRight painful ophthalmoplegia with right enophthalmos secondary to breast cancer metastasis to the right orbit.Valerie Biousse, MD; Emory Eye Center, Atlanta, Georgia
3 Vertical Diplopia secondary to Skew Deviation with Ocular Tilt Reaction with Multiple Posterior Fossa MetastasesThis is a case of multiple brain metastases in the posterior fossa resulting in a skew deviation. Figure 1 : Photograph of the patient demonstrating a spontaneous right head tilt. The patient's head is tilted toward his right shoulder to suppress his diplopia Figure 2 : Ocular movements : There is a...Rabih Hage, MD, Emory Eye Center; Valerie Biousse, MD, Emory Eye Center Atlanta, Georgia, Jason Peragallo, MD, Emory Eye Center
4 Large Sellar and Suprasellar Mass (Pituitary Macroadenoma) with Left Third Nerve Palsy and Left Optic Tract CompressionA case of a large sellar and suprasellar pituitary macroadenoma with an associated left third nerve palsy and left optic tract compression. Images from an MRI of the brain with contrast illustrate the imaging characteristics and extent of the tumor. Figure 1 : Humphrey Visual Fields (24-2 SITA-Fast)...Devin D. Mackay, MD, Emory Eye Center; Valerie Biousse, MD, Emory Eye Center Atlanta, Georgia
5 Large right hypophyseal aneurysm causing a junctional scotomaRight, multi-lobulated superior hypophyseal artery aneurysm measuring 1.6 x 1.2 x 2.2 cm with 6 mm neck causing a right junctional scotoma . Images from a brain CT with contrast, a brain CT angiography with contrast, cerebral angiogram, Humphrey visual fields and ocular fundus photographs are includ...Laurel N. Vuong, MD, Emory Eye Center, Valerie Biousse, MD, Emory Eye Center Atlanta, Georgia
6 Optical coherence tomography of the retinal nerve fiber layerA normal optical coherence tomography (OCT) of the macula is shown highlighting the position of a single retinal ganglion cell and its axon in the retinal nerve fiber layer (Figure 1). The topographical relationship of retinal ganglion cells in the retina to the visual field and position in the ante...Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
7 Vitreopapillary tractionA 64-year-old woman was referred for bilateral optic disc edema. Examination of her optic nerves showed indistinct margins at the nasal aspect of both eyes (Figure 1). Humphrey 24-2 SITA-Fast visual fields showed non-specific depressed points in both eyes (Figure 2). Optical coherence tomography (...Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
8 Ganglion cell layer analysis by optical coherence tomography (OCT)A normal optical coherence tomography (OCT) of the macula is shown (Figure 1) and the various layers of the retina are labelled (Figure 2). The cell bodies of retinal ganglion cells (RGC) are located in the ganglion cell layer (GCL) of the retina and mostly synapse in the lateral geniculate nucleus ...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
9 Incipient non-arteritic anterior ischemic optic neuropathy (NAION) evolving to symptomatic NAIONA 54-year old woman with hypertension was seen in neuro-ophthalmology consultation for asymptomatic left optic disc edema. She had a small, crowded optic disc in the right eye known as a "disc-at-risk" (Figure 1). Her visual function including 24-2 SITA-Fast Humphrey visual fields were normal in bot...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
10 Optic nerve sheath meningiomaThis is a case of an optic nerve sheath meningioma (ONSM) in a 56-year-old woman who presented with gradual, painless vision loss in her left eye. Optic disc photos at presentation showed temporal pallor of the left optic nerve (Figure 1) and Cirrus optical coherence tomography (OCT) of the retinal ...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
11 Non-arteritic anterior ischemic optic neuropathy (NAION) with segmental optic disc edemaA 75-year old white woman with hypertension and diabetes presented with a 1 week history of vision loss in the right eye. Dilated fundus examination revealed superior segmental optic disc edema in the right eye and a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1). Int...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
12 Right lateral mediullary syndrome (Wallenberg syndrome) with lateropulsion and ocular tilt reactionA 55-year old man presented with acute onset right-sided facial numbness, left-sided body numbness, vertigo, right ptosis, and binocular vertical diplopia. External examination showed right ptosis and miosis indicating a right Horner syndrome (Figure 1). He had gaze-evoked nystagmus only on right g...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
13 Junctional scotoma from a sellar massThis is a case of a 55-year-old woman presenting with gradual painless vision loss in both eyes. Although visual acuity was 20/20 in both eyes, there was a left relative afferent pupillary defect and diffuse pallor of both optic nerves (Figure 1). Visual fields (24-2 SITA-Fast) showed a temporal def...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
14 Incipient non-arteritic anterior ischemic optic neuropathy (NAION)A 61-year old white man with hypertension, diabetes, and dyslipidema was seen in neuro-ophthalmology consultation for asymptomatic right optic disc edema. He had a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1). He had normal visual function including normal 24-2 SITA...Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
15 Typical idiopathic intracranial hypertension: optic nerve appearance and brain MRI findingsA 24-year old African American woman was referred for bilateral optic disc edema that was incidentally noted on a routine eye examination. She had excellent visual function and dilated examination showed bilateral optic disc edema with peripapillary wrinkles in the right eye and pseudodrusen in the ...Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
16 Sequential non-arteritic anterior ischemic optic neuropathy (NAION)A 68-year old woman with hypertension, obstructive sleep apnea and obesity was seen in neuro-ophthalmology consultation for vision loss in the right eye. She had right optic disc edema with a small optic disc hemorrhage a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1)...Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
17 Typical idiopathic optic neuritisThis is a case of a typical optic neuritis in a 41-year-old woman presenting with vision loss and pain with eye movements in the right eye. Optic disc photos at presentation showed subtle hyperemia in the right eye (Figure 1) and optical coherence tomography (OCT) of the retinal nerve fiber layer (R...Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
18 Toxic Retinopathy: Deferoxamine ToxicityNumber of Figures and legend for each: 6 figures Figure 1: Goldmann perimetry showing large cecocentral scotomas in both eyes Figure 2: Fundus photograph of the right eye demonstrating hypopigmentation of the peripapillary and perifoveal retinal pigment epithelium (RPE) with subfoveal yellow lesions...Will Pearce, MD, Emory Eye Center Atlanta, Georgia; Valerie Biousse, MD, Emory Eye Center Atlanta, Georgia
19 Posterior Cerebral Artery Infarction from Vertebral Artery DissectionRight posterior cerebral artery ischemic infarction due to post traumatic (martial arts) left vertebral artery dissection with resulting right PCA occlusion. Left homonymous hemianopia due to right occipital lobe infarction and left hemisensory loss due to right thalamic infarction. Imaging of the a...Kristen Hudson, MD, Emory Eye Center Atlanta, Georgia; Valerie Biousse, MD, Emory Eye Center Atlanta, Georgia
20 Nonfunctiong Pituitary Adenoma with Chiasmal CompressionThis is a case of large non-functioning pituitary adenoma with mass effect on the optic chiasm inducing loss of optic nerve fibers and subsequent visual field. Figure 1: Fundus photographs demonstrating bilateral temporal optic nerve head pallor Figure 2: Humphrey visual fields demonstrating a bitem...William Pearce, MD, Emory Eye Center Atlanta, Georgia; Valerie Biousse, MD, Emory Eye Center Atlanta, Georgia
21 Radiologic Appearance of Unilateral Sphenoid Wing Hypoplasia in Neurofibromatosis Type IMRI features of greater wing sphenoid hypoplasia in the setting of neurofibromatosis type 1. - Figure 1 : Orbital MRI with contrast showing right greater sphenoid wing hypoplasia. The lack of bone tissue leads to herniation of the right temporal lobe into the orbit, pushing forward the orbital conte...Samuel Bidot, MD, Emory Eye Center Atlanta, Georgia; Amit M. Saindane, MD, Emory Eye Center Atlanta, Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
22 Pulsatile proptosis from sphenoid wing hypoplasia in neurofibromatosis type 1Clinical and radiologic features of greater wing sphenoid hypoplasia in the setting of neurofibromatosis type 1. Figure 1 : slit lamp examination showing Lisch nodules; Figure 2 : orbit CT scan (1); Figure 3 : orbit CT scan (2) with annotations. For visual examples of this disorder, please see the...Samuel Bidot, MD, Emory Eye Center Atlanta, Georgia; Amit M. Saindane, MD, Emory Eye Center Atlanta, Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
23 Ocular Hypoperfusion From Severe Internal Carotid Artery Stenosis68 year-old man complaining of mildly decreased vision OD with fluctuation of vision throughout the day. Fluorescein angiography shows delayed choroidal and retinal fillings, suggesting hypoperfusion of the right eye.Samuel Bidot, MD, Emory Eye Center Atlanta, Georgia; Amit M. Saindane, MD, Emory Eye Center Atlanta, Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
24 Osseous anatomy of the optic canalsAnatomic study of the optic canals using 3D reconstruction of CT scan images. Figure 1 : Orbital canal seen through the orbit Figure 2 : Optic canal seen from the intracranial side (1) Figure 3 : Optic canal seen from the intracranial side (2) Figure 4 : Optic canal : axial plane Figure 5 : Optic c...Samuel Bidot, MD, Emory Eye Center Atlanta, Georgia; Amit M. Saindane, MD, Emory Eye Center Atlanta, Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
25 Rathke's Cleft Cyst Apoplexy with Junctional ScotomaMRI features of Rathke's cleft cyst apoplexy. - Figure 1 : Humphrey visual fields at initial presentation - Figure 2 : Brain MRI without contrast at initial presentation - Figure 3 : Brain MRI with contrast at initial presentation - Figure 4 : Postoperative Humphrey visual fieldsSamuel Bidot, MD, Emory Eye Center Atlanta, Georgia; Amit M. Saindane, MD, Emory Eye Center Atlanta, Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
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