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1 Growing SuspicionAngela M. Herro, Norman J. Schatz, MD, Bascom Palmer Eye Institute, Linda L. Sternau, John R. Guyloss 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...
2 Under PressureNathan H. Kung, Collin M. McClelland, Gregory P. Van Stavern, MD, Associate Professor, Ophthalmology & Visual Sciences and Neurology, Washington University School of MedicineA 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...
3 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...
4 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...
5 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...
6 Who Deserves a Second Chance?Lina Nagia, Jennifer I. Doyle, Lanning B. KlineAn 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...
7 A Weak PresentationReuben M. Valenzuela, Bradley J. Katz, Alison V. Crum, Kathleen B. Digre, Nick Mamalis, Hans C. Davidson, Judith E. A. Warner, MD, Moran Eye Center, University of UtahAn 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...
8 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...
9 Star Spangled BannerDara M. Bier, Jeffrey P. Greenfield, Marc K. Rosenblum, Joseph P. Comunale Jr., Cristiano Oliveira, Marc J. DinkinA 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...
10 Three Weeks in FloridaAndrew R. Carey, J. Antonio Bermudez-Magner, Sander R. Dubovy, Norman J. Schatz, MD, Bascom Palmer Eye Institute; Linda L. Sternau, Byron L. LamA 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...
11 Nobody's PerfectAlexander Ksendzovsky, Steven A. Newman, MD, 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...
12 A Shot in the DarkJoshua Pasol, Ricardo J. Komotar, Faisal YamaniA 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...
13 Some Like it HotAhmara G. Ross, Islam M. Zaydan, Gabrielle R. Bonhomme, Ellen B. Mitchell, Tarek A. Shazly, Deborah C. ParishA 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...
14 Requiem for a Cabinet MakerJennifer I. Doyle, Michael S. Vaphiades, MD, University of Alabama, James R. Hackney, Lanning B. Kline, Lina NagiaA 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 ...
15 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...
16 Lights OutJohn J. Brinkley, John J. Chen, Patricia A. Kirby, Reid A. Longmuir, Matthew J. ThurtellA 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...
17 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...
18 SpeakeasyJoseph G. Chacko, MD, University of Arkansas, Marcus W. Moody, Harry H. Brown, Sarkis M. NazarianA 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...
19 Shady Double CrosserFrancine B. WeinHistory & 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...
20 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...
21 The Man with No Face (About Face)Michael S. Vaphiades, MD, University of Alabama; Jennifer I. Doyle, MD, Little Rock Eye Clinic; Lina Nagia, MD, Michigan State University; Kevin J. Bray, MD, Providence Health; Lanning B. Kline, MD, University of Alabama; Glenn H. Roberson, MD, University of Alabama; Adam E. Quinn, MD, Baptist Healt...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...
22 The Man with No Face (About Face)Michael S. Vaphiades, MD, University of AlabamaA 61-year-old man presented with one week history of decreased vision OS. Past medical historyincludes asthma and amblyopia OD, but with complete visual loss OD 18 years prior. He takes nomedications. He is retired but worked for 21 years in social science research. The remarkable thingupon meeting ...
23 Growing SuspicionAngela M. HerroA 44 year-old man presented to the emergency department in July 2011 for progressive painless visionloss in the right eye for 3 months. On presentation, vision was 4/200 in the right and 20/20 in the leftwith an afferent pupillary defect on the right. His visual field was full to confrontation but a...
24 Three Weeks in FloridaAndrew R. CareyA 36 year-old man presented with severe headaches, bilateral leg numbness, and bilateral decreasedvision. He was born in Ecuador where he received BCG vaccination and immigrated to US at age 19. In2005 he enrolled in nursing school and volunteered in homeless shelters. PPD was positive with anegativ...
25 Under PressureNathan H. KungA 29-year-old woman was referred to neuro-ophthalmology clinic for 1 year of headaches andpapilledema discovered 2 months earlier. She complained of recently blurred vision but no positionalheadache, pulsatile tinnitus, transient visual obscurations, or other neurologic issues. She used nomedication...
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