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51 MRI Findings in Giant Cell ArteritisCase 1. An 80-year-old Caucasian woman presented with a 10-day history of headaches, intermittent binocular diplopia, and jaw pain. Temporal artery biopsy confirmed a diagnosis of giant cell arteritis. MRI with contrast showed enhancement of bilateral optic nerve sheaths in addition to enhancement o...Wael A. Alsakran, MD; Andre Aung, MD; Valérie Biousse, MD
52 MRI Findings in Gliomatosis CerebriSingle case of gliomatosis cerebri identified on mulltiple MRI images pre- and post-contrast administration with axial and coronal views. Figure 1 : Axial brain MRI (T2) - Diffusely thickened and T2 hyperintense area (yellow arrows) centered within the genu of the corpus callosum with extension into...Jason Peragallo, MD; Valérie Biousse, MD
53 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; Valérie Biousse, MD
54 Multimodal Imaging in Ocular SyphilisA 60 year-old-man with a 3-month history of painless blurred vision was found to have bilateral disc edema. Visual function was unremarkable OU except for enlargement of the blind spot OS. Brain and Orbits MRI showed mild enhancement at the left optic disc insertion and optic disc edema OS. Multimod...George Alencastro; Valerie Biousse; Étienne Bénard-Séguin
55 Myelin Oligodendrocyte Glycoprotein (MOG) - Antibody Optic NeuritisThis is an illustrated guide to the clinical diagnosis of myelin oligodendrocyte glycoprotein (MOG)-antibody optic neuritis. Myelin oligodendrocyte glycoprotein (MOG) is a glycoprotein on the surface of myelin and is found exclusively in the central nervous system (CNS). MOG likely mediates a comple...Bryce Buchowicz, MD; Valérie Biousse, MD
56 NeurosarcoidosisThis is an illustrated guide to the clinical diagnosis of neurosarcoidosis. Sarcoidosis is a chronic systemic inflammatory disorder characterized by non-caseating granulomas. It can affect multiple organ systems including the lungs, skin, orbit, and brain. When there is central nervous system (CNS) ...Bryce Buchowicz, MD; Valérie Biousse, MD
57 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; Valérie Biousse, MD
58 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; Valérie Biousse, MD
59 Normal Retinal AnatomyNormal posterior vitreous, retinal and chroroidal anatomy (pictures, fluorescein angiography and optical coherence tomography). Figure 1: Normal fundus photograph of the left eye o a : Optic disc and fovea o b : Foveal reflex in young patients o c : Macular and foveal areas share the same center o d...Rabih Hage, MD; Valérie Biousse, MD
60 Occipital Hemorrhagic Infarction Secondary to Bacterial Endocarditis-Congruent Homonymous Scotomatous Hemianopic DefectMRI features of occipital hemorrhage secondary to bacterial endocarditis Figure 1 : Humphrey visual fields showing a congruent homonymous scotomatous hemianopic defect Figure 2 : axial gradient echo T2*w brain MRI Figure 3 : axial T1w and T2w brain MRI Figure 4 : axial postcontrast T1w brain MRISamuel Bidot, MD; Amit M. Saindane, MD; Valérie Biousse, MD
61 Occipital Infarction with Incomplete Congruent Homonymous HemianopiaCT appearance of a remote occipital infarction. Congruent homonymous hemianopia.Samuel Bidot, MD; Amit M. Saindane, MD; Valérie Biousse, MD
62 Occipital Pyogenic Abscess with Homonymous HemianopiaThis is a case of right occipital abscess with a left homonymous hemianopia. Number of Figures and legend for each: 8 figures Figure 1: Humphrey visual fields: Dense left homonymous hemianopia Figure 2: T2-weighted axial MRI : Round, hyperintense lesion (yellow arrow) in the right occipital lobe sur...Rabih Hage, MD; Valérie Biousse, MD
63 Ocular Fundus ExaminationReview of various techniques of ocular fundus examination, including direct ophthalmoscopy, binocular indirect ophthalmoscopy, slit lamp binocular indirect ophthalmoscopy, and fundus photography. Advantages and disadvantages of each technique are discussed.Devin D. Mackay, MD; Valérie Biousse, MD
64 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; Amit M. Saindane, MD; Valérie Biousse, MD
65 Ophthalmic Artery AneurysmSlideshow describing ophthalmic artery aneurysm with MRI imaging.Valérie Biousse, MD
66 Optic Disc Edema and PseudoedemaA presentation covering how to approach optic disc edema, including clinical characteristics and the distinction of pseudoedema.Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
67 Optic Disc MelanocytomaA 26-year-old woman was seen for assessment of an asymptomatic optic nerve abnormality in her left eye. Her examination showed normal afferent visual function: visual acuity: 20/30 OD and 20/25 OS; PH 20/20 OU; pupils: no relative afferent pupil defect; color vision: 14/14 plates correct OU. Humphre...Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
68 Optic Disc Pseudoedema Due to Leber Hereditary Optic NeuropathyA 23-year-old woman developed sequential painless central vision loss in both eyes (right eye 5 months ago and left eye 2 months ago). Her examination showed bilateral optic neuropathies: visual acuity: 20/300 eccentrically OU (no improvement with pinhole); pupils: equal and reactive with no relativ...Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
69 Optic Nerve Head Granuloma from SarcoidosisWe present a case of optic neuropathy with optic nerve head granuloma as the presenting sign of neurosarcoidosis. Initial patient presentation was notable for a chronic cough and worsening of vision in the left eye. Subsequent imaging revealed multiple brain lesions and the presence of a subcarinal ...Nithya Shanmugam; Valerie Biousse
70 Optic Nerve HypoplasiaThis is an illustrated guide to the clinical diagnosis of optic nerve hypoplasia. Optic nerve hypoplasia (ONH) is the most common congenital optic nerve anomaly, with an estimated incidence of 1 in 2287 live births. It may present unilaterally or bilaterally. It is seen in isolation or in associati...Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
71 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; Valérie Biousse, MD
72 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; Valérie Biousse, MD
73 Orbital and Cavernous Sinus Involvement by Herpes Zoster OphthalmicusA 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 : External photograph of dermatomal rash and s...Jason Peragallo, MD; Valérie Biousse, MD
74 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; Amit M. Saindane, MD; Valérie Biousse, MD
75 Pineal Gland Mass Causing Severe PapilledemaThe pineal gland is a neuroendocrine gland that resides in the epithalamus, at the root of the third ventricle. Due to its close proximity to the ventricles, masses in the pineal region can lead to obstruction of the flow of cerebrospinal fluid and subsequent raised intracranial pressure. Here, we p...Nithya Shanmugam; Valerie Biousse
76 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; Valérie Biousse, MD
77 Posterior Circulation Infarctions Secondary to a Post Traumatic Vertebral Artery DissectionA case of a young man with a vertebral artery dissection that caused multiple posterior circulation brain infarcts. Images from an MRI of the brain, digital subtraction angiography, and Humphrey visual fields are included. Figure 1 : Humphrey visual fields showed a right homonymous hemianopia with ...Devin D. Mackay, MD; Valérie Biousse, MD
78 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; Valérie Biousse, MD
79 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; Amit M. Saindane, MD; Valérie Biousse, MD
80 Pulsatile Proptosis ProfileSee the PowerPoint description for Pulsatile Proptosis From Sphenoid Wing Hypoplasia in Neurofibromatosis Type 1 at: http://content.lib.utah.edu/cdm/ref/collection/ehsl-eec/id/64 See also Pulsatile Proptosis Full Face video: http://content.lib.utah.edu/cdm/ref/collection/ehsl-eec/id/14Valérie Biousse, MD
81 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; Amit M. Saindane, MD; Valérie Biousse, MD
82 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; Amit M. Saindane, MD; Valérie Biousse, MD
83 Retrograde Trans-Synaptic Degeneration from a Longstanding Occipital Lobe TumorThis is an illustrated guide that (1) discusses the localization of paracentral homonymous hemianopic scotomatous visual field defects and (2) discusses the concept of trans-synaptic retrograde degeneration. A 43-year-old woman was assessed for longstanding blurred vision in both eyes. Her examinati...Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
84 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; Valérie Biousse, MD
85 Right Occipital Arteriovenous Malformation presenting as a Migraineous Visual AuraMigraine with visual aura is a distinct entity from a migraineous visual aura. A migraine with visual aura is characterized by a visual aura that does not prefer either visual field and accompanies a headache. The mechanism of the visual aura is via cortical spreading depression. A migraineous visua...Nithya Shanmugam; Fernando Labella; Valerie Biousse
86 Second Order Horner Syndrome Revealing Metastatic Squamous Cell CarcinomaHorner Syndrome is secondary to a lesion of the ipsilateral sympathetic pathway and is associated with ptosis, miosis, and anhidrosis. Here, we present a unique presentation of metastatic squamous cell carcinoma in a patient with a right-sided Horner Syndrome (second order). We also highlight the di...Nithya Shanmugam; Michael Dattilo; Valerie Biousse
87 Second Order Horner Syndrome Revealing Metastatic Squamous Cell Carcinoma (video)Horner Syndrome is secondary to a lesion of the ipsilateral sympathetic pathway and is associated with ptosis, miosis, and anhidrosis. Here, we present a unique presentation of metastatic squamous cell carcinoma in a patient with a right-sided Horner Syndrome (second order). We also highlight the di...Nithya Shanmugam; Michael Dattilo; Valerie Biousse
88 Sellar Aneurysm with Chiasmal CompressionThis is a case of aneurysm of the internal carotid artery, invading the sella and complicated by chiasmal compression and bitemporal hemianopia. Figure 1 : Humphrey visual fields (gray scale and pattern deviations) Figure 2a : T1-weighted axial brain MRI (1): well defined circular intracerebral mass...Rabih Hage, MD; Valérie Biousse, MD
89 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; Valérie Biousse, MD
90 Severe Bilateral Optic Disc Edema in Hypertensive RetinopathyHypertensive retinopathy occurs when acute or chronically high blood pressure damages the retina. Here, we present a patient with progressive blurring of vision and a blood pressure of 270/160. Fundoscopic examination revealed arteriovenous nicking, copper wiring, cotton wool spots, and flame-shaped...Nithya Shanmugam; Valerie Biousse
91 Sturge-Weber SyndromeA case of Sturge-Weber syndrome (Encephalotrigeminal angiomatosis) with angiomas that involve the leptomeninges, and the skin of the ipsilateral hemiface, associated with congenital glaucoma in the same eye. Various illustrations are included to demonstrate the port wine stain, enlarged optic nerve ...Supharat Jariyakosol, MD; Valérie Biousse, MD
92 Superior Segmental Optic Nerve HypoplasiaThis is a case of superior segmental optic nerve hypoplasia in a woman with a history of maternal diabetes. A 25 year-old woman noticed a visual field defect in her right eye. Her examination showed: visual acuity: 20/20 OD, 20/20 OS; pupils: trace relative afferent pupillary defect OD; color visi...Naa Naamuah M. Tagoe, MBChB, FWACS, FGCS; Rahul A. Sharma, MD, MPH; Valérie Biousse, MD; Nancy J. Newman, MD
93 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; Valérie Biousse, MD
94 Terson Syndrome With Cranial Nerve 3 Palsy Due to Subarachnoid Hemorrhage from Arteriovenous Malformation and Aneurysmal RuptureA case of Terson syndrome due to AVM and posteral cerebral aneurysm. The patient developed a left CN3 palsy due to hematoma involving the left midbrain. Figure 1 : External photograph of right eye demonstrates blunted red reflex secondary to vitreous hemorrhage Figure 2 : External photograph of lef...Joshua Levinson, MD; Valérie Biousse, MD
95 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; Valérie Biousse, MD
96 Toxoplasmic Chorioretinitis with Unilateral Disc EdemaA 53-year-old man had a history of high myopia and a seronegative spondyloarthropathy treated with immunosuppressive agents. He presented with mild, painless vision loss in his right eye. His examination showed findings of a right anterior optic neuropathy: visual acuity: 20/20 OD (right eye), 20/20...Rahul A. Sharma, MD, MPH; Nancy J. Newman, MD; Valérie Biousse, MD
97 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; Valérie Biousse, MD
98 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; Valérie Biousse, MD
99 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; Valérie Biousse, MD; Jason Peragallo, MD
100 Vitreomacular Traction Syndrome (VMTS)Vitreomacular traction (VMT) syndrome is characterized by an abnormal vitreous adherence to the macula due to incomplete posterior vitreous detachment (PVD). The resulting traction produces morphological changes of the macula. Patients may complain of decreased visual acuity, photopsia, micropsia, o...Kirstyn Taylor; Sachin Kedar, MD
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