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1 In the Thick of ItKannan M. Narayana; Ritesh A. Ramdhani; Bradford Tannen; Laura J. Balcer; Steven L. Galetta; Janet C. RuckerA 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...
2 When a WEINO Goes Blind - VideoRustum Karanjia, Chiara La Morgia, Christina Liang, Carolyn Sue, Valerio Carelli, Peter A Quiros, Alfredo A. Sadun, MD, PhD, Flora L. Thornton Chair, Professor of Ophthalmology and Neurological Surgery, Keck School of Medicine at USCA 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...
3 Not a Meatball - VideoSteven A. Newman, M.D., University of Virginia School of Medicine, James Mandell, Colleen Druzgal, John Jane Jr., Spencer Payne, Sugoto Mukherjee, Beatriz LopesIn 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...
4 Masquerade - VideoAmanda D. Henderson; Jacques J. Morcos; Oliver G. Fischer; Joshua PasolA 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...
5 Heart of Darkness - VideoShira Simon, Shiraaz I. Rahman, John C. Heymann, Bahram Rahmani, Nicholas J Volpe, MD, Northwestern UniversityAn 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...
6 "Not Right in the Head" - VideoMelinda Y. Chang, MD; Janet Lee, MD; Robert A. Goldberg, MD; Stacy L. Pineles, MDA 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, ...
7 It Is, Is It Not? - VideoIvana Vodopivec, Derek H. Oakley, Nagagopal Venna, John H. Stone, E. Tessa Hedley-Whyte, Sashank Prasad, MD, Brigham and Women's HospitalA 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...
8 Avengers Assemble! - VideoRadha Ram, Carrie A. Mohila, Jeremy Y. Jones, Veeral S. ShahA 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...
9 Leopard Can't Change Its Spots - VideoTerry S. Kang, Veeral S. ShahAn 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...
10 Is It or Isn't It? - VideoPeter W. MacIntosh, Scott Jones, Milena Stocic, Amy Lin, Heather MossA 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...
11 Eyes and Bowels Bottled Up - VideoKristopher Kowal, Jonathan Daniel Trobe MD, Michigan University, Theodore T. BrownA 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. ...
12 A Night at the Met - VideoClotilde Hainline, Janet C. Rucker, David Zagzag, Yvonne W. Liu, Floyd A. Warren, Laura J. Balcer, MD, Professor, Department of Neurology, NYU Langone; Steven L. Galetta, MD, NYU LangoneA 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...
13 Growing Up Too Fast - VideoCourtney E. Francis, Thomas T. Chia, Gordana Juric-Sekhar, Manuel FerreiraA 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...
14 Many Small Lesions, One Big Problem - VideoHarsh V. Gupta, Tuhin Virmani, Rohan Samant, Murat Gokden, Joseph G. Chacko, M.D., University of Arkansas, Sarkis M. NazarianA 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...
15 Diplopic Uveitis - VideoKinda Najem, Edward Margolin, Pradeep Krishnan33 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...
16 Looking for a Drop of Porcelain - VideoShannon J. Beres, MD; Grant T. Liu, MDA 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...
17 A Case of Progressive Orbital Cellulitis in an Immunocompetent Patient - VideoCinthi Pillai, MD, NYU Langone; Ivana Vodopivec, MD, Brigham and Women's Hospital; Daniel Lefebvre, MD, Massachusetts Eye and Ear; Frederick A. Jakobiec, MD, DSc, Massachusetts Eye and Ear; Joseph F. Rizzo III, MD, Massachusetts Eye and EarA 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...
18 The Good, The Bad, and The Ugly - VideoNathan H. Kung, Robert C. Bucelli, Gregory P. Van Stavern, MD, Associate Professor, Ophthalmology & Visual Sciences and Neurology, Washington University School of MedicineA 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...
19 I Can't See StraightSteven A. Newman; T. Ben AblemanIn 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...
20 Using MuscleNagham Al-Zubidi; John E. Carter; Bundhit Tantawongski; Patricia Chevez-Barrios; Lyndon Tyler; Constance L. FryA 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...
21 Nobody's PerfectAlexander Ksendzovsky; Steven A. Newman, M.D., University of Virginia School of MedicineIn 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...
22 Joe & Jerry Flew the CoopLulu LCD Bursztyn, MD, Ivey Eye Institute; Dane A. Breker, MD, Sanford Neuroscience Clinic; Andrew W. Stacey, MD, University of Washington Medicine; Ashok Srinivasan, MBBS, University of Michigan; Mark W. Johnson, MD, Kellogg Eye Center; Jonathan Daniel Trobe MD, Michigan UniversityA 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...
23 The Relationship Between PDE-5 Inhibitors and NAIONHoward D. Pomeranz, MDSildenafil 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...
24 Hiding and Out of SightMichael M. Morgan; Sumayya J. Almarzouqi; Patricia Chevez-Barrios; Amina I. Malik; Andrew G. LeeA 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...
25 It's Not Just a FAD (EHR Fatigue Syndrome)Jacqueline A. Leavitt; John J. Chen; Diva R. SalomaoA 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...
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