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1 Funduscopic Findings of Acute Central Retinal Artery OcclusionA 59-year-old man was referred for assessment acute vision loss in the right eye. His examination showed: best-corrected visual acuity: light perception OD, 20/20 OS; pupils: Relative afferent pupillary defect OD; color vision: unable to visualize control plate OD, 14/14 OS correct Ishihara plates. ...David B. Enfield, MD, Ophthalmology Resident, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, 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 MRI findings in optic nerve and chiasmal glioma in childhoodMultiple cases of optic pathway gliomas are demonstrated using MRI imaging. The optic pathway gliomas are identified at multiple points in the optic pathways. Figure 1 : Patient 1: Axial orbital MRI (T1 postcontrast with fat suppression) showing thickening and enhancement of the right optic nerve a...Jason Peragallo, MD, Emory Eye Center; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
4 Occipital Infarction with Incomplete Congruent Homonymous HemianopiaCT appearance of a remote occipital infarction. Congruent homonymous hemianopia.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
5 Anterior and Posterior ScleritisA case of anterior and posterior scleritis secondary to idiopathic orbital inflammation, also known as orbital pseudotumor. Various imaging modalities are included to demonstrate optic disc edema, macular edema, and fluid in tenon's capsule which may be seen in posterior scleritis. Figure 1 : Exter...Joshua Levinson, MD, Emory Eye Center Atlanta, Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
6 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
7 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
8 Fundus AutofluorescenceThe retinal pigment epithelium (RPE) has many important functions including phagocytosis of the photoreceptor outer segments. The metabolism of the photoreceptor outer segments leads to the formation of lipofuscin. Disease states and potentially increased oxidative damage can lead to the buildup of ...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 Terson Syndrome and Subarachnoid HemorrhageA case of Terson syndrome resulting with subarachnoid hemorrhage and right vitreous hemorrhage resulting from a left pericallosal artery aneurysm. Figure 1 : External photograph of right eye demonstrates blunted red reflex secondary to vitreous hemorrhage Figure 2 : External photograph of left eye d...Joshua Levinson, MD, Emory Eye Center Atlanta, Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
10 Orbital and cavernous sinus involvement by herpes zoster ophthalmicusBrief paragraph (or more) describing item : A single case of the effects of herpes zoster is demonstrated using external photographs and MRI imaging. The effects demonstrated include the typical dermatomal rash as well as extraocular muscle invovlement and cavernous sinus involvement. Figure 1 : ...Jason Peragallo, MD, Emory Eye Center; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
11 IVth Nerve SchwannomaThis is a case of IVth cranial nerve schwannoma, showing an enhancement in the subarachnoid space consistent with the clinical presentation. Figure 1a : T1-weighted axial brain MRI Figure 1b : T1-weighted axial brain MRI : magnification of the brainstem Figure 1c : T1-weighted axial brain MRI : cr...Rabih Hage, MD, Emory Eye Center Atlanta Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
12 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
13 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
14 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
15 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
16 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
17 Colloid cyst HydrocephalusThis is a case of colloid cyst of the third ventricle complicated by severe hydrocephalus, raised intracranial pressure and papilledema. Figure 1: Fundus photographs demonstrating bilateral optic nerve head edema Figure 2a and 2b: T1-weighted axial brain MRI without contrast: Dilation of both later...Rabih Hage, MD, Emory Eye Center Atlanta Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
18 Large Frontal Meningioma with Mass Effect and Increased Intracranial PressureThis is a case of frontal meningioma presenting with raised intracranial pressure and bilateral papilledema responsible for visual loss. Figure 1: Goldmann visual field of the left eye. In the right eye, there was no response to the V4e. The visual field is severely constricted in the left eye. Fig...Rabih Hage, MD, Emory Eye Center Atlanta Georgia; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
19 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
20 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
21 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
22 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
23 Cotton wool spots in giant cell arteritisThis is a case of cotton wool spots in a patient with temporal artery-biopsy proven temporal arteritis.; ; A 66-year-old woman presents with isolated painless vision loss related to a left optic neuropathy in her left eye. She denies systemic symptoms to suggest giant cell arteritis.; Her examinatio...Rahul A. Sharma, MD, MPH, Neuro-ophthalmology Fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of M...
24 Homonymous Hemianopia Secondary to an Intracranial Bleed from an Arteriovenous MalformationThis case demonstrates a homonymous hemianopia resulting from hemorrhage secondary to a ruptured intracranial arteriovenous malformation (AVM), providing grounds for illustration and discussion of the correlations between localization of this lesion on cerebral imaging and resultant visual field and...Lauren Hudson, MD, PhD, Ophthalmology resident, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of Medicin...
25 Previous Branch Retinal Artery OcclusionThis is a typical case of an old branch retinal artery occlusion in a 64 year old woman presenting with persistent monocular vision loss. She had sudden onset of painless vision loss in the inferior field of her left eye approximately one year prior. Her past medical history was significant for atri...Benson S. Chen, MBChB FRACP,Neuro-ophthalmology fellow, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD, Cyrus H. Stoner Professor of Ophthalmology, Professor of Ophthalmology and Neurology, Departments of Ophthalmology and Neurology, Emory University School of...
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