The Walsh Society Annual Meeting Archives: Proceedings of the annual meeting of the Walsh Society, which is now part of the North American Neuro-Ophthalmology Association (NANOS) Annual Meeting. Contains records from the first meeting in 1969, through the present.
NOVEL: https://novel.utah.edu/
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| Title | Creator | History | ||
|---|---|---|---|---|
| 1 |
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A Nod to the Nodule | Natalie Brossard; Kirill Zaslavski; Laila Al-Shafai; David Munoz; Edward Margolin | A 67-year-old man presented to emergency department in March'21 with 6hours h/o fever, headache, confusion, right- sided weakness and urinary incontinence. He had h/o hypertension, rheumatoid arthritis, spinal stenosis and was taking etanercept/leflunomide/sulfasalazine. Non-contrasted CT showed lef... |
| 2 |
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A 4-Year Wait | Dmitry Balian; Sachin Kedar; Michaelyn Everhart; Aleh Bobr; Liudmila Muinov | A 64 year old male with past history of hypertension, arthritis and chronic headache developed transient tingling and numbness of his left face in February 2016 and was diagnosed to have 'trigeminal neuralgia'. Two months later, he presented to the ED with sudden onset of binocular tilted diplopia. ... |
| 3 |
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Frizzle Frazzled | Eric Gaier; Farrah Rajabi; Anne Fulton; Gyula Acsadi; David Waitzman | An otherwise healthy 12-year-old boy originally from Palestine was referred for refractory papilledema secondary to familial IIH. He has a history of fully accommodative esotropia with onset age 2-3. At age 9, elevated optic nerves prompted a neuro-ophthalmic referral. Best corrected visual acuities... |
| 4 |
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Oh My GAD!! Something Else? | Olwen Murphy; Kemar Green; John Probasco; Daniel Gold | A 43 -year-old man presented with oscillopsia, dizziness, binocular vertical diplopia, and gait difficulties. He reported a six-month history of abdominal pain, anorexia and 50-pound weight loss, and a 3-month history of mood and cognitive changes. Torsional nystagmus, a left 4th nerve palsy (NP), u... |
| 5 |
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Never Too Young or Too Old | Bart Chwalisz; Laurel Tainsh; Mary Maher; Samantha Champion; Shuhei Nishiyima; Michael Levy | An 81-year-old woman with history of ocular myasthenia gravis presented with sequential bilateral vision loss. Six days before presentation, she discovered that vision of her left eye was reduced to light perception. She did not have any eye pain, pain with eye movement, headache, scalp tenderness, ... |
| 6 |
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Gone but Not Forgotten | Jonathan Micieli; Adriana Krizova; Walter Montanera | A 52 -year-old healthy woman presented with a 1-week history of blurred vision and 'soreness' in her left eye. Neuro-ophthalmic examination revealed a visual acuity of 20/20 OD, 20/40 OS, left RAPD and left superior arcuate defect on Humphrey visual field testing. Dilated fundus examination demonstr... |
| 7 |
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A Small Leak Will Sink a Great Ship | Konstantinos Douglas; Vivian Paraskevi Douglas; Cameron Sadegh; David Chow; Sigurros Davidsdottir; Ganesh Shankar; Bradley Buchbinder; Bart Chwalisz | A 68 -year-old right -handed man presented for evaluation of progressive and fluctuating polyopia, gait instability and cognitive changes of about 14 months. Prior medical history was notable for Crohn's disease in remission, atrial fibrillation, a single episode of aseptic meningitis 12 years prior... |
| 8 |
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Orbiting a Diagnosis | Daniel Liebman; Daniel Lefebvre; Emily Tam; Marie Lithgow; Bart Chwalisz; Eric Gaier; Joseph Kane | A 75 -year-old male with a history of chronic/small lymphocytic leukemia (CLL/SLL) presented for one day of left retro-orbital headache, painful eye movements, eyelid swelling, and diplopia. One week prior, his WBC count was 39.9 K/uL with 86% lymphocytes. Three days prior to presentation, the patie... |
| 9 |
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X' Marks the Spot | Luis Andre Leal Ferman; Leslie Bruch; John Buatti; Jeremy Greenlee | This 24 year-old man presented with several months of progressive visual loss in both eyes. His past medical, surgical and ocular history was unremarkable. There was no family history of phacomatosis. He complained of occasional binocular diplopia, but denied headaches or any other neurological symp... |
| 10 |
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Sometimes a Biopsy is Best | Kevin Chodnicki; Natalie Wolkow; Michael Yoon; Bart Chwalisz | A 30 -year-old pregnant woman without significant medical or ocular history presented with decreased right eye vision. In her 2nd trimester, she was diagnosed with Lyme disease with a bulls-eye rash and positive Lyme antibodies; she was treated with two weeks of amoxicillin. At 33 weeks pregnant she... |
| 11 |
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A Definite Maybe | Raghu Mudumbai; Alex Solomon | 73 yo man French-Canadian presented to our institution for another opinion for a long standing diagnosis of Oculopharyngeal Dystrophy given at an outside institution. 17 years ago, the patient developed unfluctuating double vision that progressed to include severe, unfluctuating ptosis and mild dysp... |
| 12 |
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Are We 'Tilting At Windmills'? (Video) | Michael Vaphiades | A 52-year-old African American woman presented to her primary care physician with a 4 week history of headaches, nausea, vomiting, fever and ataxia. Her medical history includes rheumatoid arthritis, hypertension and a recent diagnosis of pulmonary; sarcoidosis for which she was taking 20 mg of pred... |
| 13 |
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Smoke Gets in Your Eyes (Video) | Tatiana Bakaeva; John Gittinger, Jr | A 61-year-old woman, active smoker with history of COPD, presented with bilateral progressive vision loss and ataxia. Four months prior to her presentation she developed 'black spot' in her right eye (OD) and was found to have 'OD disc edema and right hypertropia' by an outside ophthalmologist. She ... |
| 14 |
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Oh Oh Oh It's Magic, You Know…Never Believe It's Not So! (Video) | Zeeshan Haq; Jeremy Tanner; Christine Glastonbury; Cathryn Cadwell; Brooks Crawford; Elan Guterman; Maulik Shah; Megan Richie; Nailyn Rasool | A 72-year-old man with chronic sinusitis, obstructive sleep apnea, and recent extensive travel presented with right-sided headaches, vision changes, and allergy symptoms. A head CT demonstrated a sinus infection and he was treated with amoxicillin-clavulanate; and prednisone. His headache persisted ... |
| 15 |
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Undiscovered Islands - So Close, Yet So Far (Video) | Magdalena Wirth; Farahna Sabiq; Mehdi Agoumi | A 30-year old female, visiting Canada from India, presented to ophthalmology with a 2-day history of right periorbital swelling, painful proptosis, fevers and chills. Initial examination suggested a clinical diagnosis of post-septal cellulitis with mild motility restriction, without optic nerve comp... |
| 16 |
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Tumefictive MS (Video) | Anthony Brune III; Hemant Parmar; Sandra Camelo-Piragua; Lindsey De Lott | A 26-year-old woman with history of diabetes insipidus and hypothyroidism presented for evaluation of painless vision loss in her right eye. She was evaluated by a local neurologist and multiple sclerosis (MS) specialist who diagnosed acute optic neuritis. MRI brain showed an enhancing T2 hyperinten... |
| 17 |
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Bones of the Past (Video) | Bart Chwalisz; Konstantinos Douglas; Vivian Douglas; Otto Rapalino | A 44-year-old woman presented with two episodes of binocular horizontal diplopia within one year. She had a history of Cushing's syndrome status post transsphenoidal resection and bilateral adrenalectomy 4 years prior, hypertension, and secondary diabetes mellitus. Nine months prior she developed se... |
| 18 |
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You're Too Young for That! (Video) | Sravanthi Vegunta; Kathleen Digre; Bradley Katz; Meagan Seay; Alison Crum; Edward Quigley; Sean Kennedy; Nick Mamalis; Judith Warner | An 11-year old boy presented with right orbital pain for two months with recent double vision. He had no recent viral illnesses or sick contacts. He had no past medical history. His brother had Kawasaki disease; his paternal grandmother had rheumatoid arthritis; and his father died of a myocardial i... |
| 19 |
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Not All Men With Thick Skulls Have High Testosterone (Video) | Prem Subramanian | A 54-year-old retired USAF fighter pilot was referred in Aug 2016 for evaluation of possible bilateral optic disc swelling noted on routine optometric examination. His past medical history included low testosterone discovered 2 years prior in the context of fatigue and exercise intolerance. MRI brai... |
| 20 |
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Close Encounters of the Third Kind (Video) | Trishal Jeeval-Patel; Danny Mandell | A 65-year old woman started experiencing headaches which increased in severity over two weeks. She eventually sought care in the emergency department. Neurological examination was reported as normal. Unenhanced CT of the brain was performed and reported as normal. Headaches continued and she was pre... |
| 21 |
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Look in the Back (Video) | Tatiana Deveney; Aristides Capizzano; Jonathan Trobe | A 59-year old man with Graves disease developed increasing proptosis and diplopia. Attributing these abnormalities to worsening of the Graves disease, an ophthalmologist treated him with high-dose oral and intravenous corticosteroids. When improvement did not occur, he underwent orbital x-irradiatio... |
| 22 |
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A Par 3 Macular Hole? (Video) | Archana Srinivasan; Jerald Gong; Mark Moster | A 78-year old woman with 3-week history of sudden onset 'visual blur' OU and difficulty reading was evaluated by her ophthalmologist and suspected to have macular hole secondary to posterior vitreous detachment and vitreomacular traction (VMT). Her past medical history was significant for hypertensi... |
| 23 |
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A Trip Through the Wormhole | Anne Kao | The patient initially presented to me at age 19 years with a 'throbbing, aching pressure' behind her right eye and swelling of the right upper eyelid. Her pain was worse in lateral gaze, although she denied diplopia. She had been prescribed 60mg of prednisone by the referring provider, which reduced... |
| 24 |
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A Zebra Among Zebras | Peter Mortensen; Gabrielle Bonhomme | 61-year-old man with Type 2 diabetes and hypertension presented to outside hospital ED with fever, headache, and neck pain. Onset of neck pain was one week prior, with worsening of symptoms following chiropractic manipulation. Patient was evaluated at outpatient clinic one day prior and given Medrol... |
| 25 |
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The Great Masquerade | Bart Chwalisz; Dean Cestari | A 56-year-old man with unremarkable prior history complained of visual and somatosensory disturbances. Five months prior, he had an episode of being unable to see oncoming traffic. He developed transient visual disturbances lasting minutes in the left hemifield, e.g., the right sides of people's fac... |
| 26 |
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Fire and Ice | Mary Maher; Joah Aliancy; Gul Moonis; Angela Lignelli; Michael Kazim; Jeffrey Odel | A 14 year-old boy, with ADHD on amphetamine and dextroamphetamine, presented with headache and bilateral decreased vision. Seven days prior, he began experiencing bilateral non-positional frontal headache unresponsive to NSAIDS that did not wake him from sleep. Five days prior, he felt fatigued and ... |
| 27 |
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A-deno What's Going On! | Christine Greer; Salina Teja; Jennifer Danesch; Anna Mathew; Vivek Patel; Kimberly Gokoffski | A 68 year-old Hispanic female with hypertension, type II diabetes mellitus, panhypopituitarism after pituitary adenoma resection 30 years prior and subsequent radiation therapy presented with decreased vision in the left eye and severe headache. The patient's vision in the left eye declined in the p... |
| 28 |
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A Sad Story - Video | Jason Peragallo | A healthy 6-year-old boy had a two-week history of progressive headaches associated with nausea and vomiting. An ER diagnosed allergic rhinitis, treated with augmentin and steroids, however his symptoms worsened. At a second ER he was febrile to 103F. A classmate was recently diagnosed with Erlichio... |
| 29 |
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Looking for a Drop of Porcelain - Video | Shannon J. Beres; Grant T. Liu | A 4 year old healthy boy presented with severe headache. A right subdural hygroma was seen on brain MRI and CSF evaluation showed a leukocytosis with elevated protein. A week later he developed left leg weakness and a repeat brain MRI showed progressive leptomeningeal enhancement and new punctate in... |
| 30 |
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Heart of Darkness - Video | Shira Simon; Shiraaz I. Rahman; John C. Heymann; Bahram Rahmani; Nicholas J. Volpe | An 18 year-old woman presented to the emergency department in October 2014 with three days of blurred vision in her left eye. Past medical history included a hypoplastic right heart status-post orthotopic heart transplant at 2 months of age, chronic kidney disease with BK viremia since 12 years of a... |
| 31 |
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Is It or Isn't It? - Video | Peter W. MacIntosh; Scott Jones; Milena Stocic; Amy Lin; Heather Moss | A 58-year-old woman with recurrent left idiopathic orbital inflammation (IOI) presented with one day of rapidly progressive bilateral proptosis, edema, right eye redness, photophobia, and blurry vision. Her right eye had previously been asymptomatic. Her left eye had macular scarring with reduced vi... |
| 32 |
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Many Small Lesions, One Big Problem - Video | Harsh V. Gupta; Tuhin Virmani; Rohan Samant; Murat Gokden; Joseph G. Chacko; Sarkis M. Nazarian | A 73-year old hypertensive and hyperlipidemic man presented with 18 months of horizontal diplopia, worse at distance and gaze right, oscillopsia on left head turn, and unsteady gait. Six months prior to consult, he developed dysphagia, worse with liquids, and recurrent falls forced him to use a walk... |
| 33 |
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It Is, Is It Not? - Video | Ivana Vodopivec; Derek H. Oakley; Nagagopal Venna; John H. Stone; E. Tessa Hedley-Whyte; Sashank Prasad | A 44-year-old man presented with visual loss, confusion, apraxia, and left-sided weakness. His medical history included retinal vasculopathy, chronic kidney disease, hypertension, and hypertensive cardiomyopathy that had presented over the preceding six years. The retinal vasculopathy had been terme... |
| 34 |
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Avengers Assemble! - Video | Radha Ram; Carrie A. Mohila; Jeremy Y. Jones; Veeral S. Shah | A five-year-old otherwise healthy boy presented with a two-week history of behavioral changes, nausea, vomiting, headache, and subacute vision loss bilaterally. Six weeks prior to presentation to our hospital, he had presented to an outside hospital with esotropia and blurred vision in both eyes. At... |
| 35 |
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Leopard Can't Change Its Spots - Video | Terry S. Kang; Veeral S. Shah | An 8 year-old Caucasian female presented with bilateral conjunctivitis, photophobia, and blurred vision. Visual acuity was 20/50 OD and 20/60 OS. She had 2-3+ anterior chamber cell and flare OU, 1+ vitreous cells OU, 2+ optic disc edema OU, and macular edema OU. She was diagnosed with anterior uveit... |
| 36 |
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A Night at the Met - Video | Clotilde Hainline; Janet C. Rucker; David Zagzag; Yvonne W. Liu; Floyd A. Warren; Laura J. Balcer; Steven L. Galetta | A 73-year old woman with no headache history presented to the emergency department with several days of right-sided, retro-ocular, and vertex headaches and inability to see the left side of the TV screen-- all beginning 1 week after cataract surgery. Evaluation by her ophthalmologist was unrevealing... |
| 37 |
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Growing Up Too Fast - Video | Courtney E. Francis; Thomas T. Chia; Gordana Juric-Sekhar; Manuel Ferreira | A 7 ½ year old boy presented in 2000 with precocious puberty (development of pubic hair, acne and rapid linear growth). Work-up included a brain MRI revealing a suprasellar mass, consistent with a visual pathway glioma. On ophthalmologic evaluation, he was noted to be 20/25 OU with a normal fundusc... |
| 38 |
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Diplopic Uveitis - Video | Kinda Najem; Edward Margolin; Pradeep Krishnan | 33 year-old man presented with 3 days of binocular diplopia. Visual acuity was 20/30 OU and pupillary exam was normal. Motility testing demonstrated right partial 3rd nerve palsy (no adduction and limited supraduction with complete ptosis). There were +1/2 anterior chamber cells and few vitreous cel... |
| 39 |
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A Case of Progressive Orbital Cellulitis in an Immunocompetent Patient - Video | Cinthi Pillai; Ivana Vodopivec; Daniel Lefebvre; Frederick Jakobiec; Joseph Rizzo | A 74 year-old woman presented 2/7/2015 with left orbital swelling/discomfort. Imaging revealed paranasal sinus and orbital soft tissue abnormalities suggestive of inflammatory/infectious disease. She received intravenous vancomycin/meropenam but worsened. Medical history was notable for paroxysmal a... |
| 40 |
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The Good, The Bad, and The Ugly - Video | Nathan H. Kung; Robert C. Bucelli; Gregory P. Van Stavern | A 37-year-old man with a history of hearing loss presented to the Neuro-Ophthalmology clinic in 2014 with 1 month of decreased vision in the left visual field. He also reported a period of binocular horizontal diplopia, similar in all directions of gaze, which had since resolved. Past medical histor... |
| 41 |
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Masquerade - Video | Amanda D. Henderson; Jacques J. Morcos; Oliver G. Fischer; Joshua Pasol | A 68 year-old man from Nicaragua, with a past medical history of diabetes and hypertension, presented with a one-year history of right-sided headaches, diplopia, and a four-month history of sudden vision loss in his right eye. In Nicaragua, a head CT and an angiogram had revealed a sphenoid wing and... |
| 42 |
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When a WEINO Goes Blind - Video | Rustum Karanjia; Chiara La Morgia; Christina Liang; Carolyn Sue; Valerio Carelli; Peter A. Quiros; Alfredo A. Sadun | A 16 year old male presented to an outside center with binocular horizontal diplopia. His symptoms began approximately six months prior when he noticed difficulty reading. He was seen by an optometrist and prescribed reading glasses. His vision was 20/66 in the right eye and 20/25 in the left eye. H... |
| 43 |
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Not a Meatball - Video | Steven Newman; James Mandell; Colleen Druzgal; John Jane Jr.; Spencer Payne; Sugoto Mukherjee; Beatriz Lopes | In April 2015, a 10 year old girl was referred for a four day history of ptosis and double vision. On examination, visual acuity was 20/20-OU; near vision was 3pt OU. Visual fields showed subtle arcuate visual field changes. External examination revealed palpebral fissures of 6.5 and 9 with an upper... |
| 44 |
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Eyes and Bowels Bottled Up - Video | Kristopher Kowal; Jonathan D. Trobe; Theodore T. Brown | A 56 year-old man presented with diplopia and ptosis. Actually he was more concerned about severe constipation that had started about the same time. Abdominal x-rays had shown stool loading; laxatives had been ineffective. Our exam showed bilateral ptosis with complete ophthalmoplegia in both eyes. ... |
| 45 |
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Not Right in the Head' - Video | Melinda Y. Chang; Janet Lee; Robert A. Goldberg; Stacy L. Pineles | A 55 year old man presented with eight months of progressive left orbital swelling. His past ocular history was significant for LASIK of the right eye with monovision. His past medical history was significant for melanoma of the left arm, treated by surgical excision, with two negative lymph nodes, ... |
| 46 |
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In the Thick of It | Kannan Narayana; Ritesh Ramdhani; Bradford Tannen; Laura Balcer; Steven Galetta; Janet Rucker | A 38 year-old woman with a history of premature birth with significant developmental delay was sent for neuroophthalmic evaluation for excessive head movements with gaze shifting. As an adult, she was verbal and able to take the bus alone to a day program. Over the past two years, language and cogni... |
| 47 |
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Growing Suspicion | Angela M. Herro; Norman J. Schatz; Linda L. Sternau; John R. Guy | loss in the right eye for 3 months. On presentation, vision was 4/200 in the right and 20/20 in the left with an afferent pupillary defect on the right. His visual field was full to confrontation but automated perimetry revealed a central scotoma. The remainder of the exam was normal with the except... |
| 48 |
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Under Pressure | Nathan H. Kung; Collin M. McClelland; Gregory P. Van Stavern | A 29-year-old woman was referred to neuro-ophthalmology clinic for 1 year of headaches and papilledema discovered 2 months earlier. She complained of recently blurred vision but no positional headache, pulsatile tinnitus, transient visual obscurations, or other neurologic issues. She used no medicat... |
| 49 |
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The Relationship Between PDE-5 Inhibitors and NAION | Howard D. Pomeranz, MD | Sildenafil was first synthesized by pharmaceutical chemists working at Pfizer. It was initially studied for use in hypertension and angina. Phase I clinical trials suggested that the drug had little effect on angina but could induce penile erection. Sildenafil (Viagra®) was patented in 1996 and app... |
| 50 |
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Hiding and Out of Sight | Michael L. Morgan; Sumayya J. Almarzouqi; Patricia Chevez-Barrios; Amina I. Malik; Andrew G. Lee | A 75-year-old white woman presented with a history of biopsy-proven giant cell arteritis (GCA) presented with recurrence of severe left sided headaches and left global ophthalmoparesis for 4 days. GCA had been diagnosed 4 months prior by biopsy. Left eye vision loss occurred when an outside physicia... |
| 51 |
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Who Deserves a Second Chance? | Lina Nagia; Jennifer Doyle; Lanning Kline | An 81-year-old woman presents with a one-month history of blurred vision OS, acutely worse in the past 5 days. She reports pain with left gaze, left sided forehead tenderness and some weight loss. Medical history includes hypertension, borderline diabetes, cerebral vascular accident and basal cell c... |
| 52 |
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A Weak Presentation | Reuben M. Valenzuela; Bradley Katz; Alison Crum; Kathleen B. Digre; Nick Mamalis; Hans C. Davidson; Judith Warner | An 82-year-old right-handed man with myasthenia gravis presented in May 2014 with double vision and right facial numbness and weakness. He was first seen in 1998 with horizontal diplopia. He had an abduction deficit of the right eye, and right nasolabial fold flattening. He was diagnosed with myasth... |
| 53 |
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I Can't See Straight | Steven A. Newman; T. Ben Ableman | In May of 2014 this 30 year old right handed patient was referred for consultation regarding diplopia and dizziness. The patient relates that she had been told that she had 'tired eyes' as a child. Two and a half years ago she began to have intermittent exodeviation. She was seen locally and diagnos... |
| 54 |
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Star Spangled Banner | Dara M. Bier; Jeffrey P. Greenfield; Marc K. Rosenblum; Joseph Comunale; Cristiano Oliveira; Marc J. Dinkin | A 12-year-old girl with a history of bilateral optic nerve enlargement, enterovirus meningitis, seizures, and bilateral hygromas, presented with acute onset chronic vision loss in her left eye. Two years prior, she presented to an outside hospital with headaches, intermittent speech arrest and right... |
| 55 |
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Three Weeks in Florida | Andrew R. Carey; J. Antonio Bermudez-Magner; Sander R. Dubovy; Norman J. Schatz; Linda L. Sternau; Byron L. Lam | A 36 year-old man presented with severe headaches, bilateral leg numbness, and bilateral decreased vision. He was born in Ecuador where he received BCG vaccination and immigrated to US at age 19. In 2005 he enrolled in nursing school and volunteered in homeless shelters. PPD was positive with a nega... |
| 56 |
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Nobody's Perfect | Alexander Ksendzovsky; Steven A. Newman | In June of 2006 an 8 year old patient was referred for evaluation. Apparently at age 1 ½ she had developed headaches and was found to have a posterior fossa tumor. In El Salvador she was treated with shunting and chemotherapy plus radiation therapy for presumed medulloblastoma. She underwent a shun... |
| 57 |
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A Shot in the Dark | Joshua Pasol; Ricardo Komotar; Feisal Yamani | A 74 year-old man with a chief complaint of difficulty with night time driving for several years as well as difficulty going from a lighted room to a dark room. PMH of high cholesterol, BPH, hypothyroidism, GERD, glottic squamous cell cancer without recurrence, and a prior history of alcoholism. POH... |
| 58 |
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Some Like it Hot | Ahmara G. Ross; Islam Zaydan; Gabrielle Bonhomme; Ellen Mitchell; Tarek Shazly; Deborah Parrish | A 71 year old Caucasian man with a past medical history of hypertension, hyperlipidemia, Type 2 DM, ESRD status post renal transplant, facial melanoma, currently on ASA for a stable left sided putaminal hemorrhage presented with new right sided ptosis and lower extremity weakness. Brain MRI obtained... |
| 59 |
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Requiem for a Cabinet Maker | Jennifer I. Doyle; Michael S. Vaphiades; James R. Hackney; Lanning B. Kline; Lina Nagia | A 54-year-old white male presents with 3 weeks of painless horizontal nystagmus and 6 months of left sided forehead numbness. He reports a 20 lbs weight loss. Medical history includes a renal transplant 30 years prior. He takes prednisone 30 mg QOD and azathioprine. Visual acuity is 20/20 OU, color ... |
| 60 |
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Using Muscle | Nagham Al-Zubidi; John E. Carter; Bundhit Tantawongski; Patricia Chevez-Barrios; Lyndon Tyler; Constance L. Fry | A 30- year-old Saudi female student with no past medical history presented an eight month history of progressive blurred vision primarily at near, anisocoria OS, and periocular discomfort with eye movements. Neuro-Ophthalmologic examination revealed best corrected visual acuity of OD 20/20 and OS 20... |
| 61 |
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Lights Out | John J. Brinkley; John J. Chen; Patricia A. Kirby; Reid A. Longmuir; Matthew J. Thurtell | A 78 year-old man presented with a one-month history of progressive painless binocular vision loss. He had sustained head trauma without loss of consciousness three days prior to the onset of vision loss. On the morning of his presentation to us, he had awoken with complete binocular vision loss and... |
| 62 |
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It's Not Just a FAD (EHR Fatigue Syndrome) | Jacqueline A. Leavitt; John J. Chen; Diva R. Salomao | A 29 year-old female nurse, nine months postpartum, presented with an inability to see her computer well for the past two months. She denied eye pain, diplopia, numbness, tingling or weakness. There were no changes in vision in bright vs. dim lighting. She also had a headache at the back of her head... |
| 63 |
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Speakeasy | Joseph G. Chacko; Marcus Moody; Harry H. Brown; Sarkis Nazarian | A 64 year-old Caucasian gentleman presented with an unusual complaint. He stated that if he touched the inside of his right cheek with his tongue, he felt a tingly sensation in his R eyebrow. This had started one month ago. He also complained of foreign body sensation and discomfort in the right eye... |
| 64 |
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Shady Double Crosser | Francine Wein | History & Exam A 62-year-old woman presented with a one-month history of severe light sensitivity and headache, and a two week history of diplopia. Her photophobia was severe enough for her to wear sunglasses indoors. Her past medical history was significant for a cholecystectomy and Crohn's disease... |
| 65 |
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Joe & Jerry Flew the Coop | Lulu L.C.D. Bursztyn; Dane A Breker; Andrew W. Stacey; Ashok Srinivasan; Mark W. Johnson; Jonathan D. Trobe | A previously healthy 13-year-old girl presented to a local hospital with fever and myalgia, followed one day later by lethargy and vision loss. Past medical history was significant only for acne, for which she had been treated with doxycycline 40 mg/day intermittently starting 2 months prior to symp... |
| 66 |
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The Man with No Face (About Face) | Michael Vaphiades; Jennifer Doyle; Lina Nagia; Kevin Bray; Kline Lanning; Glenn Roberson; Adam Quinn; Joel Cure; Katherine Fening | A 61-year-old man presented with one week history of decreased vision OS. Past medical history includes asthma and amblyopia OD, but with complete visual loss OD 18 years prior. He takes no medications. He is retired but worked for 21 years in social science research. The remarkable thing upon meeti... |
| 67 |
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Ataxia at the Masquerade Ball | Krista I. Kinard; Alison V. Crum; Judith E. Warner; Bradley J. Katz; Joshua A. Sonnen; Cheryl A. Palmer; Anne G. Osborn; L. Dana DeWitt; Kathleen B. Digre | A 52-year-old right-handed salesman presented in July 2007 with a 5-year history of slowly progressive imbalance. In 2002 he developed difficulty using his eyes together and then imbalance resulting in frequent backward falls. He reported oscillopsia and episodic vertigo. He later developed fatigue,... |
| 68 |
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It's Not the Tumor | Courtney E. Francis | A 58 year old woman with a history of metastatic parotid adenocarcinoma presented with bilateral vision loss over 2 months. She had undergone surgical resection of the tumor followed by fractionated external beam radiation with a total of 66.6 Gy 18 months prior to presentation. She was recently fou... |
| 69 |
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Blame it on the Pill | Sachin Kedar; Padmaja Sudhakar; Stuart Tobin; William O. Connor; Fernando Decastro | Three months earlier, he had been evaluated for malaise and weight loss and found to have lymphopenia, elevated TSH (20.3) and anti-thyroid peroxidase antibody (2874) with normal T3, ESR, B12 and folate. |
| 70 |
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Muscle Bound or Unbound? | Dane A. Breker; Jonathan D. Trobe; Ann A. Little; Sandra I. Camelo-Piragua | A 52 year old former Olympic athlete developed myalgias, cramping, and stiffness in the upper arms, chest, thigh, and calves in 2009 after a blood transfusion for hematochezia attributed to antiplatelet treatment following coronary stenting. Symptoms were worst in the morning, when he could not walk... |
| 71 |
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Renal Red Herring | John J. Chen; John J. Brinkley; Namrata Singh; Amanda C. Maltry; Bruno A. Policeni; Richard C. Allen; Reid A. Longmuir; Matthew J. Thurtell | A 71 year-old Caucasian male with a history of Wegener's granulomatosis presented with vision loss OU and horizontal binocular diplopia. His past medical history was significant for Wegener's granulomatosis, which was diagnosed in 2000 on the basis of a renal biopsy. He was previously treated with v... |
| 72 |
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Is it a Crime to be Blind? I plead the 4th! | Jasmine Gopwani; Edward Margolin; Tran Le; Wayne Cornblath; Rasmus Kiehl | A 30 year old previously healthy man from Sudan presented to a community hospital with a seizure. MRI revealed a 'right frontal lobe tumor'. Brain biopsy was performed but the pathology findings were inconclusive. Initial interpretation was "brain tissue with increased cellularity consistent with gl... |
| 73 |
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I Can't Stand the Double Vision | Iris Ben Bassat Mizrachi; Ruth Huna-Baron; Rivka Inzelberg; Yonathan Sharabi | A 37 year-old woman was referred to our clinic due to bilateral ptosis and vertical binocular diplopia. She denied diurnal variations, muscle weakness or bulbar symptoms. In the past year she had been suffering from bouts of abdominal pain, diarrhea, and severe weight loss (>40 pounds), and she pres... |
| 74 |
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A Candid Look at a Missed Diagnosis | Edward Margolin; Jasmine Gopwani; Robert Willinsky | She was diagnosed with migraine, stress, and 'drug seeking' presumed from a history of past (intravenous?) heroin use. |
| 75 |
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Almost Catastrophic | Danielle S. Rudich; Samuel Yun; Anne Liebling; Jonathan E. Silbert; Robert L. Lesser | A 36 year-old Caucasian male presented to his ophthalmologist with one month of headache, blurry vision, and intermittent diplopia. The patient denied transient visual obscurations, tinnitus, prior medical problems or use of steroids/Vitamin A/antibiotics. He was 235 pounds and 5'9". Because examina... |
| 76 |
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A TAAD Bit Unusual | Nisreen K. Mesiwala; Susan T. Stefko | A 12 year-old previously healthy boy presented to the emergency room with a five-day history of progressive frontal headaches and acute onset of horizontal, binocular diplopia on left gaze. He had no significant medical history and his only significant ocular history was mild myopia and X-linked col... |
| 77 |
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Innocent until Proven Guilty | Heather E. Moss; Tiffany Stroup; Amy Lin; Oliver Graf; Jeffrey Borgeson; Aaron Halfpenny; Howard Lipton; Tibor Valyi-Nagy | A 31 year-old male experienced right eye blurring and pain. He was diagnosed with optic neuritis and treated with IV steroids. Nine days later he developed headache, worsening vision, speech trouble and right-sided weakness. Two days later he developed low-grade fever and trouble walking. He had NLP... |
| 78 |
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More Than a Cu-bit of Vision Loss | Philip M. Skidd; Rebecca C. Stacy; Waqar Waheed; Mohamed-Ali Babi | A 45 year-old, right-handed, man, presented after awakening with no vision in his left eye. Two days earlier he had experienced a brief episode of binocular horizontal, and then oblique, diplopia. One week prior, he developed left facial numbness and "sinus pain" on the same side; a five day course ... |
| 79 |
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Much-Ado About Acute Vision Loss | Mahsa A. Sohrab; Andrea Birnbaum; Michael Sidiropoulos; Lois Polatnick; Nicholas J. Volpe | Progressive fatigue and right face, arm, and leg pain. |
| 80 |
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Burned by Diplopia | Bonnie M. Keung; Reuben Mari Valenzuela; Meena Gujrati; Jeffrey R. DeSanto; Jorge C. Kattah; John H. Pula | In March 2012 he sustained a concussion and forehead laceration from a motor vehicle accident. In August 2012, he developed painless, binocular, vertical diplopia, which limited him from painting art. In November 2012, his examination showed -2 limitation of up-gaze OD. |
| 81 |
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Wear and Tear Vision | Konrad P. Weber; Caterina Schweier; Veronika Kana; Thomas Guggi; Katarzyna Byber; Klara Landau | A 66-year-old woman presented with a four-month history of insidious bilateral visual loss. Ophthalmologic examination revealed visual acuity reduced to finger counting in both eyes. On fundus examination, maculae and optic discs appeared normal. Visual fields showed bilateral central scotoma with m... |
| 82 |
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Which One is The Real Zebra | Madhura A. Tamhankar; Julia Kharlip; Robert Lustig; Jon Burnham; Karuna Shekdar; Michele Paessler; Lucy Rorke; Kristina Cole | A 15-year-old male complained of headaches and nausea, two months after appendectomy. |
| 83 |
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A Case of Cotton Wool Spots | Golnaz Moazami; Hermann Schubert; Sampson Jacinda; Riley Claire | A 31 year old Caucasian male was admitted to a local ER after being found unresponsive on a couch at home, incontinent of urine, and having vomited with tongue bruising. He was arousable in the ER but febrile to 102 F with WBC= 19,000. He was loaded with dilantin, and emergency CT showed a left post... |
| 84 |
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It's Deja Vu All Over Again | Aileen A. Antonio-Santos; Yanny L. Phillips; Baha El Khatib; Howard T. Chang; David I. Kaufman; Eric R. Eggenberger | A 51-year-old male with a history of amblyopia OD presented in February 1999 with hyperemia, swelling and periorbital pain of the left eye. Visual acuity (VA) was 20/80 OD and 20/25 OS; color vision was 10/11 Ishihara plates OU, and Goldmann perimetry showed an inferior quadrantanopia OS. There was ... |
| 85 |
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Beware the Trojan Horse | Denize Atan; Nithin Nair; Mrinal Rana; Swarupsinh V. Chavda; Andrew Jacks | Systemic hypertension, hypercholesterolemia, and cerebrovascular disease treated with an antiplatelet drug, thiazide diuretic, ACE inhibitor and statin. |
| 86 |
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An Ironclad Case of Vision Loss | Marc J. Dinkin; George Parlitsis; Sarju Patel; Alex Merkler; Audrey Schuetz; Cristiano Oliveira | A 43-year-old man with AIDS and a CD4 count of 4, non-compliant with HAART, presented with four days of headache, photophobia and vision loss in his left eye. There was a history of treated syphilis and CMV retinopathy. On neuro- ophthalmological examination, visual acuities were 20/40 OD (formerly ... |
| 87 |
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Double Vision? - Give Your Head a Shake | Vivek Patel; Danah Albreiki | 3 month history of constant binocular oblique diplopia with mild worsening, progressive disequilibrium, and a wide based gait. No vertigo, loss of coordination, loss of vision or oscillpsia, hearing loss, or tinnitus. No history of cancer, hypothyroidism, GI malabsorption or anemia. Occupational his... |
| 88 |
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Spots, Spots Everywhere, And Not A Spot To See | Sarkis M. Nazarian; Kelli Y. Shaon; Kenneth R. Habetz; Ayman Al-Salaimeh; John D. Schwankhaus; Joseph G. Chacko | Additional history revealed that the patient had suffered a tick bite about two weeks prior to the onset of his rash. |
| 89 |
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A Wolf in Bear's Clothing | Peter W. MacIntosh; Agatha Bogard; Pete Setabutr; Heather E. Moss | An eleven-month-old African-American girl with medical history of reactive airway disease developed a bump and bags under both eyes which her mother attributed to minor trauma. There were no signs of systemic illness. A week later, her mother noticed more prominent right eye edema and a new bump beh... |
| 90 |
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Golden Grapes | Heather E. Moss; Sean Zivin; Amy Lin; Vinay Aakalu; Senad Osmanovic; Omar Al Heeti; Stockton Mayer; Mahesh Patel | A 71 year-old African American woman presented with a painful right retrobulbar optic neuropathy and weight loss. ESR was 74. She was treated with steroids. Temporal artery biopsy did not show arteritis. Nine days later, while on a steroid taper, she developed fevers, worsening right eye vision, pto... |
| 91 |
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Diabetes Does Not Explain It All | Philip M. Skidd; Joseph F. Rizzo; Florian S. Eichler; Dean Cestari | Systemic hypertension, type II diabetes mellitus, hypercholesteremia, anxiety and depression. |
| 92 |
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No Rhabdo? | Mark R. Melson | A 5 year-old girl presented for evaluation of a right orbital mass displacing the globe superiorly. She had a 5 week history of swelling around her right eye. Her pediatrician diagnosed a blocked tear duct and referred her to an ophthalmologist. She failed empiric treatment for orbital cellulitis an... |
| 93 |
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Sacramentum Gladiatorium | Michael Vaphiades; Jennifer Doyle | Medical history includes hypertension and hyperlipidemia. |
| 94 |
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Raise Your Grade Point Average | Hilary M. Grabe; Jeffrey L. Myers; Douglas J. Quint; Victor M. Elner; Jonathan D. Trobe | Two years earlier, he had had persistent hearing loss in the left ear attributed elsewhere to infection. One year later, he developed left facial weakness diagnosed as Bell's palsy, treated with corticosteroids without recovery. A few months later, he became hoarse and had difficulty swallowing. |
| 95 |
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Ain't No Sunshine When You Are Gone! | Veeral S. Shah; Linda Sternau; Michelle Felicella; Sanders Dubovy; Chris Alabiad; Norman J. Schatz; Byron L. Lam | An 18 year-old Latin American female presented with progressive visual loss OD over 6 weeks. She initially had blurry vision and photophobia OD with a central scotoma OD on HVF testing. At that time, examination revealed a right swollen optic nerve with retinal hemorrhages. She was otherwise healthy... |
| 96 |
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Some Orbital Confusion | Steven A. Newman; David T. Bourne | In September 2006 he had been referred for a second opinion regarding a 5 year history of intermittent swelling around the right orbit, worsening over 7 months associated with double vision, and proptosis (C,D). |
| 97 |
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Clues Hidden in the Skin | Janet C. Rucker; Catherine Cho; James Weisfeld-Adams; Scott Brodie | She underwent neurological evaluation at age 32 (neuroimaging, serologies, lumbar puncture, muscle biopsy) with no resultant diagnosis (records unavailable). She required a wheelchair by age 36 and gradually developed slurred speech, cognitive decline, and worsened motor function. Simultaneous with ... |
| 98 |
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Occam's Razor or Gamma Knife? | Kaushal M. Kulkarni; Linda Sternau; Byron L. Lam | Hypertension, end-stage renal disease on hemodialysis, and an episode of anterior uveitis in the right eye 10 years earlier. |
| 99 |
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‘Tis Nobler in the Mind to Suffer... Or to Take Arms Against a Sea of Troubles and by Opposing End Them? (Hamlet act 3, scene 1) (Presentation Video) | Heather Moss; Goo Lee; C. Michael Weldon-Linne | 41-year old female with a shadow over the left eye. |
| 100 |
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When Life Gives You Lymphocytes, Make Limeade (Presentation Video) | Melissa Ko; Monika Kolloori; Barbara Henriquez; Robert Hutchison; Luis Mejico | A 62-year old female; hypercholesterolemia. |