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1 Thinking Outside of the LinesCarleigh Bruce; Thomas Clark; Gregory Griepentrog; Andrea Stahulak; Mariam RatianiA 61-year-old male with past medical history of long-standing cocaine abuse presented with ten days of painless acute; vision loss in his right eye (OD). Initial exam revealed a visual acuity (VA) 20/100 OD, relative afferent pupillary defect; (rAPD) OD, dyschromatopsia OD, hypertropia with impaired...
2 Just a Flu?Lily 'Tali' Okrent Smolar; Veronika Yehezkeli; Fani Segev; Feda Fanadka; Sachin Kedar; Yehoshua AlmogA thirteen-year-old boy with no significant past medical history presented to the pediatric emergency department (ED) with; progressive right eyelid swelling, decreased appetite, general malaise and obtundation. A week prior to presentation, he; had flu like illness with fever, headache, ear pain, n...
3 Waiting for That ‘Bing' Moment to Get the DiagnosisJenny Hepschke; J. Virdee; Richard BlanchA 55yo Caucasian female initially presented to her GP with a new onset headaches, scalp tenderness, shoulder arthralgia,; night sweats and loss of appetite. Bloods platelets of 379, ESR 26 and CRP of 4. She was diagnosed with Giant cell arteritis; (GCA) and empirically treated with oral Prednisolone...
4 Double CrossedJeffrey Gluckstein; Melanie Lang-Orsini; Joseph RizzoA 58-year-old man presented for the development of new stabbing headaches and blurry vision in the right eye. Over; several months, his symptoms progressed to 'smudging' of his temporal field in the right eye, difficulty separating similar; colors, and binocular horizontal diplopia worse at near. Me...
5 All in the FamilyHomer Chiang; Shannon BeresA previously healthy 2-year-old male presented to neuro-ophthalmology clinic for a head turn that started 1.5 months ago; and his left eye began turning in over the last 2 weeks. He had no recent infections, vaccinations, or illnesses. With the birth; of his new baby sister 6 weeks prior the family ...
6 Waiting for That ‘Bing' Moment to Get the DiagnosisJenny Hepschke; J. Virdee; Richard BlanchA 55yo Caucasian female initially presented to her GP with a new onset headaches, scalp tenderness, shoulder arthralgia,; night sweats and loss of appetite. Bloods platelets of 379, ESR 26 and CRP of 4. She was diagnosed with Giant cell arteritis; (GCA) and empirically treated with oral Prednisolone...
7 An Apple a DayJoseph Fong; James O'Brien; Anil PatelA 73-year-old female presented with a 4-month-history of gradually worsening binocular oblique diplopia, right upper; eyelid ptosis, right-sided facial weakness, and facial pain and paresthesia in the right V1 and V2 distribution. She presented; with a prior diagnosis of trigeminal neuralgia as a re...
8 A Nod to the NoduleNatalie Brossard; Kirill Zaslavski; Laila Al-Shafai; David Munoz; Edward MargolinA 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...
9 The Grey Area of White MatterParker Bohm; Leanne Stunkel; Gregory Van StavernA 76 year-old man presented with two months of progressive confusion, vision loss, and left-sided weakness. His medical; history was notable for hypothyroidism, type 2 diabetes mellitus, coronary artery disease, basal cell carcinoma of the; forehead status-post excision, deep vein thrombosis, and se...
10 Pseudo-Pseudotumor Cerebri?Etienne Benard-Seguin; Abdullah Al-Ani; Kris Langdon; Rajiv Midha; Paula de Robles; Fiona CostelloA 23-year-old female to male transgender patient (BMI=30) on testosterone therapy presented to the urgent clinic with; bilateral disc swelling and preserved optic disc function (Figure 1a-1b). He had a 5 day history of general malaise. Past; medical history was pertinent for scoliosis surgery at age...
11 The Nidus of the NeuropathyHeather McDonald; Adrian Budhram; J. Alexander Fraser; Lulu LCD BursztynA 57-year-old female presented with a one-year history of paresthesias, gait instability, slurred speech, peripheral; numbness, and fatigue. A non-contrast CT Head showed lower density in the corpus callosum. Follow-up MR Head showed; T2/FLAIR hyperintensity and diffusion restriction in the splenium...
12 The Inconspicuous CystsLily Zhang; Folusakin Ayoade; Julio Diaz PerezA previously healthy 40-year-old male, with a past medical history significant for latent tuberculosis s/p treatment 15 years; ago, presented with blurry vision and progressively worsening headaches for 6 months. He was originally from Guatemala; and moved to the US in 2001 (crossed the deserts thro...
13 The Inconspicuous CystsLily Zhang; Folusakin Ayoade; Julio Diaz PerezA previously healthy 40-year-old male, with a past medical history significant for latent tuberculosis s/p treatment 15 years; ago, presented with blurry vision and progressively worsening headaches for 6 months. He was originally from Guatemala; and moved to the US in 2001 (crossed the deserts thro...
14 Pseudo-Pseudotumor Cerebri?Etienne Benard-Seguin; Abdullah Al-Ani; Kris Langdon; Rajiv Midha; Paula de Robles; Fiona CostelloA 23-year-old female to male transgender patient (BMI=30) on testosterone therapy presented to the urgent clinic with; bilateral disc swelling and preserved optic disc function (Figure 1a-1b). He had a 5 day history of general malaise. Past; medical history was pertinent for scoliosis surgery at age...
15 A Nod to the NoduleNatalie Brossard; Kirill Zaslavski; Laila Al-Shafai; David Munoz; Edward MargolinA 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...
16 Not Another IgG4 Case!Anne KaoA 34 year-old woman was referred from the allergist for painless swelling of bilateral upper eyelids for 11 months, after; moving from Alabama to her current state of residence. Her past medical history was significant for anemia. Review of; systems was notable for fatigue, daily headaches, and inte...
17 Hydrocephalus Appetizer, TED Entrée, Side of Bipolar Disease. Would You Like a Meatball With That?Eric Caskey; Bradley Katz; Bhupendra Patel; Roger Harrie; Meagan Seay; Benjamin Witt; Yoshimi Anzai; Alison Crum; Judith Warner1, Kathleen DigreA 74-year-old man presented with a one year history of progressive, asymmetric proptosis. His past medical history by bilateral optic neuropathy, thyroid eye disease complicated by lithium treatment for bipolar disease, benign prostatic included hydrocephalus associated with aqueductal stenosis, sta...
18 WD-40: A Multi-Use ProductGeorgia Kaidonis; Melike Pekmezci; Jessica Van Ziffle; Jonathan HortonA 15-year-old female with a history of syndactyly, brachydactyly and patent ductus arteriosus presented with declining; vision and new onset of headache. She was referred for neuro-ophthalmology evaluation. Best corrected acuity was 20/40; in the right eye and 20/100 in the left eye. The pupillary r...
19 Some Heads Are Harder Than OthersSteven NewmanA 56 year old right handed patient was referred for an 'orbital problem.' Ten years earlier he had been told that nothing; could be done about the fact that his right eye position was not normal. In August 2015 vision was 20/50 OD and 20/300; OS, with the decreased vision on the left felt related to...
20 Is the Treatment Working? Yes, the Patient Is Getting Worse!Walid Bouthour; Heimo SteffenA 46-year-old woman from Gambia with no prior medical history presented to the ophthalmology clinic for progressive; blurred vision, headache, and weight loss over the past two months. Her best corrected visual acuity was finger count in the; right eye and 20/20 in the left eye. There was an asymmet...
21 Hydrocephalus Appetizer, TED Entrée, Side of Bipolar Disease. Would You Like a Meatball With That?Eric Caskey; Bradley Katz; Bhupendra Patel; Roger Harrie; Meagan Seay; Benjamin Witt; Yoshimi Anzai; Alison Crum; Judith Warner1, Kathleen DigreA 74-year-old man presented with a one year history of progressive, asymmetric proptosis. His past medical history by bilateral optic neuropathy, thyroid eye disease complicated by lithium treatment for bipolar disease, benign prostatic included hydrocephalus associated with aqueductal stenosis, sta...
22 Is the Treatment Working? Yes, the Patient Is Getting Worse!Walid Bouthour; Heimo SteffenA 46-year-old woman from Gambia with no prior medical history presented to the ophthalmology clinic for progressive; blurred vision, headache, and weight loss over the past two months. Her best corrected visual acuity was finger count in the; right eye and 20/20 in the left eye. There was an asymmet...
23 A Nod to the NoduleNatalie Brossard; Kirill Zaslavski; Laila Al-Shafai; David Munoz; Edward MargolinA 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...
24 Frizzle FrazzledEric Gaier; Farrah Rajabi; Anne Fulton; Gyula Acsadi; David WaitzmanAn 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...
25 A 4-Year WaitDmitry Balian; Sachin Kedar; Michaelyn Everhart; Aleh Bobr; Liudmila MuinovA 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. ...
26 X' Marks the SpotLuis Andre Leal Ferman; Leslie Bruch; John Buatti; Jeremy GreenleeThis 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...
27 Sometimes a Biopsy is BestKevin Chodnicki; Natalie Wolkow; Michael Yoon; Bart ChwaliszA 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...
28 X' Marks the SpotLuis Andre Leal Ferman; Leslie Bruch; John Buatti; Jeremy GreenleeThis 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...
29 A 4-Year WaitDmitry Balian; Sachin Kedar; Michaelyn Everhart; Aleh Bobr; Liudmila MuinovA 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. ...
30 Frizzle FrazzledEric Gaier; Farrah Rajabi; Anne Fulton; Gyula Acsadi; David WaitzmanAn 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...
31 Never Too Young or Too OldBart Chwalisz; Laurel Tainsh; Mary Maher; Samantha Champion; Shuhei Nishiyima; Michael LevyAn 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, ...
32 Never Too Young or Too OldBart Chwalisz; Laurel Tainsh; Mary Maher; Samantha Champion; Shuhei Nishiyima; Michael LevyAn 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, ...
33 Sometimes a Biopsy is BestKevin Chodnicki; Natalie Wolkow; Michael Yoon; Bart ChwaliszA 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...
34 Sometimes a Biopsy is BestKevin Chodnicki; Natalie Wolkow; Michael Yoon; Bart ChwaliszA 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...
35 Never Too Young or Too OldBart Chwalisz; Laurel Tainsh; Mary Maher; Samantha Champion; Shuhei Nishiyima; Michael LevyAn 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, ...
36 Frizzle FrazzledEric Gaier; Farrah Rajabi; Anne Fulton; Gyula Acsadi; David WaitzmanAn 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...
37 X' Marks the SpotLuis Andre Leal Ferman; Leslie Bruch; John Buatti; Jeremy GreenleeThis 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...
38 A 4-Year WaitDmitry Balian; Sachin Kedar; Michaelyn Everhart; Aleh Bobr; Liudmila MuinovA 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. ...
39 A Small Leak Will Sink a Great ShipKonstantinos Douglas; Vivian Paraskevi Douglas; Cameron Sadegh; David Chow; Sigurros Davidsdottir; Ganesh Shankar; Bradley Buchbinder; Bart ChwaliszA 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...
40 Orbiting a DiagnosisDaniel Liebman; Daniel Lefebvre; Emily Tam; Marie Lithgow; Bart Chwalisz; Eric Gaier; Joseph KaneA 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...
41 Orbiting a DiagnosisDaniel Liebman; Daniel Lefebvre; Emily Tam; Marie Lithgow; Bart Chwalisz; Eric Gaier; Joseph KaneA 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...
42 Gone but Not ForgottenJonathan Micieli; Adriana Krizova; Walter MontaneraA 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...
43 A Small Leak Will Sink a Great ShipKonstantinos Douglas; Vivian Paraskevi Douglas; Cameron Sadegh; David Chow; Sigurros Davidsdottir; Ganesh Shankar; Bradley Buchbinder; Bart ChwaliszA 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...
44 A Definite MaybeRaghu Mudumbai; Alex Solomon73 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...
45 Oh My GAD!! Something Else?Olwen Murphy; Kemar Green; John Probasco; Daniel GoldA 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...
46 Gone but Not ForgottenJonathan Micieli; Adriana Krizova; Walter MontaneraA 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...
47 A Definite MaybeRaghu Mudumbai; Alex Solomon73 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...
48 Oh My GAD!! Something Else?Olwen Murphy; Kemar Green; John Probasco; Daniel GoldA 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...
49 A Small Leak Will Sink a Great ShipKonstantinos Douglas; Vivian Paraskevi Douglas; Cameron Sadegh; David Chow; Sigurros Davidsdottir; Ganesh Shankar; Bradley Buchbinder; Bart ChwaliszA 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...
50 A Definite MaybeRaghu Mudumbai; Alex Solomon73 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...
51 Orbiting a DiagnosisDaniel Liebman; Daniel Lefebvre; Emily Tam; Marie Lithgow; Bart Chwalisz; Eric Gaier; Joseph KaneA 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...
52 Oh My GAD!! Something Else?Olwen Murphy; Kemar Green; John Probasco; Daniel GoldA 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...
53 Bones of the Past (PDF)Bart Chwalisz; Konstantinos Douglas; Vivian Douglas; Otto RapalinoA 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...
54 Bones of the Past (Slides)Bart Chwalisz; Konstantinos Douglas; Vivian Douglas; Otto RapalinoA 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...
55 Tumefictive MS (PDF)Anthony Brune III; Hemant Parmar; Sandra Camelo-Piragua; Lindsey De LottA 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...
56 Tumefictive MS (Slides)Anthony Brune III; Hemant Parmar; Sandra Camelo-Piragua; Lindsey De LottA 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...
57 Are We 'Tilting At Windmills'? (Video)Michael VaphiadesA 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...
58 Look in the Back (Video)Tatiana Deveney; Aristides Capizzano; Jonathan TrobeA 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...
59 Are We 'Tilting At Windmills'? (PDF)Michael VaphiadesA 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...
60 Look in the Back (PDF)Tatiana Deveney; Aristides Capizzano; Jonathan TrobeA 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...
61 Objects Jumping, Body Bumping, Hearing Slumping…Quick, He is Crumping (PDF)Jorge Kattah; Scott Eggers; Sarah BachA 45 y/o man developed insidious unsteadiness and bilateral hearing impairment. A neurosurgeon diagnosed possible myelopathy, and despite an anterior cervical discectomy, he noted progressive gait difficulty, poor handwriting, and inability to play the guitar. Additionally, dysarthria, oscillopsia a...
62 Objects Jumping, Body Bumping, Hearing Slumping…Quick, He is Crumping (Video)Jorge Kattah; Scott Eggers; Sarah BachA 45 y/o man developed insidious unsteadiness and bilateral hearing impairment. A neurosurgeon diagnosed possible myelopathy, and despite an anterior cervical discectomy, he noted progressive gait difficulty, poor handwriting, and inability to play the guitar. Additionally, dysarthria, oscillopsia a...
63 From Brainstem to Stern (Slides)Neena Cherayil; Angela Viane; Grant Liu; Ali HamedaniA previously healthy 32-year-old man complained of diplopia and one month of worsening positional headaches. He then acutely developed confusion and chills, prompting ER referral. Further history was limited by altered mental status. On presentation, he was afebrile and encephalopathic. Serum WBC wa...
64 A Myel-In, a Long Way to Go (Slides)Aishwarya Pareek; Timothy Lotze; Gail Demmler; Brandon Tran; William Whitehead; Carrie Mohila; Veeral ShahA 9-year-old previously healthy female with two recent admissions for presumed diagnosis of ADEM re-presented with persistent headache and ataxic gait. During her initial admissions, she presented with fever, acute onset of ataxia, facial asymmetry and abnormal eye movements. Inpatient ocular exam s...
65 Are We 'Tilting At Windmills'? (Slides)Michael VaphiadesA 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...
66 Objects Jumping, Body Bumping, Hearing Slumping…Quick, He is Crumping (Slides)Jorge Kattah; Scott Eggers; Sarah BachA 45 y/o man developed insidious unsteadiness and bilateral hearing impairment. A neurosurgeon diagnosed possible myelopathy, and despite an anterior cervical discectomy, he noted progressive gait difficulty, poor handwriting, and inability to play the guitar. Additionally, dysarthria, oscillopsia a...
67 Look in the Back (Slides)Tatiana Deveney; Aristides Capizzano; Jonathan TrobeA 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...
68 A Myel-In, a Long Way to Go (Video)Aishwarya Pareek; Timothy Lotze; Gail Demmler; Brandon Tran; William Whitehead; Carrie Mohila; Veeral ShahA 9-year-old previously healthy female with two recent admissions for presumed diagnosis of ADEM re-presented with persistent headache and ataxic gait. During her initial admissions, she presented with fever, acute onset of ataxia, facial asymmetry and abnormal eye movements. Inpatient ocular exam s...
69 From Brainstem to Stern (Video)Neena Cherayil; Angela Viane; Grant Liu; Ali HamedaniA previously healthy 32-year-old man complained of diplopia and one month of worsening positional headaches. He then acutely developed confusion and chills, prompting ER referral. Further history was limited by altered mental status. On presentation, he was afebrile and encephalopathic. Serum WBC wa...
70 A Myel-In, a Long Way to Go (PDF)Aishwarya Pareek; Timothy Lotze; Gail Demmler; Brandon Tran; William Whitehead; Carrie Mohila; Veeral ShahA 9-year-old previously healthy female with two recent admissions for presumed diagnosis of ADEM re-presented with persistent headache and ataxic gait. During her initial admissions, she presented with fever, acute onset of ataxia, facial asymmetry and abnormal eye movements. Inpatient ocular exam s...
71 Smoke Gets in Your Eyes (PDF)Tatiana Bakaeva; John Gittinger, JrA 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 ...
72 Oh Oh Oh It's Magic, You Know…Never Believe It's Not So! (PDF)Zeeshan Haq; Jeremy Tanner; Christine Glastonbury; Cathryn Cadwell; Brooks Crawford; Elan Guterman; Maulik Shah; Megan Richie; Nailyn RasoolA 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 ...
73 Smoke Gets in Your Eyes (Video)Tatiana Bakaeva; John Gittinger, JrA 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 ...
74 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 RasoolA 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 ...
75 Bones of the Past (Video)Bart Chwalisz; Konstantinos Douglas; Vivian Douglas; Otto RapalinoA 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...
76 Undiscovered Islands - So Close, Yet So Far (PDF)Magdalena Wirth; Farahna Sabiq; Mehdi AgoumiA 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...
77 Close Encounters of the Third Kind (PDF)Trishal Jeeval-Patel; Danny MandellA 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...
78 A Par 3 Macular Hole? (PDF)Archana Srinivasan; Jerald Gong; Mark MosterA 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...
79 Undiscovered Islands - So Close, Yet So Far (Video)Magdalena Wirth; Farahna Sabiq; Mehdi AgoumiA 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...
80 Close Encounters of the Third Kind (Video)Trishal Jeeval-Patel; Danny MandellA 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...
81 A Par 3 Macular Hole? (Video)Archana Srinivasan; Jerald Gong; Mark MosterA 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...
82 Close Encounters of the Third Kind (Slides)Trishal Jeeval-Patel; Danny MandellA 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...
83 Oh Oh Oh It's Magic, You Know…Never Believe It's Not So! (Slides)Zeeshan Haq; Jeremy Tanner; Christine Glastonbury; Cathryn Cadwell; Brooks Crawford; Elan Guterman; Maulik Shah; Megan Richie; Nailyn RasoolA 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 ...
84 Undiscovered Islands - So Close, Yet So Far (Slides)Magdalena Wirth; Farahna Sabiq; Mehdi AgoumiA 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...
85 A Par 3 Macular Hole? (Slides)Archana Srinivasan; Jerald Gong; Mark MosterA 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...
86 Smoke Gets in Your Eyes (Slides)Tatiana Bakaeva; John Gittinger, JrA 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 ...
87 From Brainstem to Stern (PDF)Neena Cherayil; Angela Viane; Grant Liu; Ali HamedaniA previously healthy 32-year-old man complained of diplopia and one month of worsening positional headaches. He then acutely developed confusion and chills, prompting ER referral. Further history was limited by altered mental status. On presentation, he was afebrile and encephalopathic. Serum WBC wa...
88 Not All Men with Thick Skulls Have High Testosterone (PDF)Prem SubramanianA 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...
89 Well Here Is Another Uveo-Meningeal Syndrome You Might Muck Up (PDF)David DeLeon; Mariel Rojas; Francisco Sanchez; Rosa Tang; Julie Patel; Jade SchiffmanA 16 y/o Caucasian female with a BMI of 24, went for an eye exam for blurry vision which corrected with refraction, however bilateral disc edema was found. There was a 4-year history of headaches that were intermittent and escalating in nature around 5 days a week, about 1 hour after awakening, and ...
90 Tissue Is the Issue (PDF)Christine Greer; Jasmine Francis; Eli Diamond; Charles Eberhart; Marc DinkinThe pathologic specimen demonstrated atypical histiocytic proliferation and infiltration with abundant cytoplasm, CD68+, S100+, consistent with Rosai Dorfman (RDD). The patient had been treated with steroids with a partial response and disease stabilization with radiation therapy with subsequent pro...
91 Tumefictive MS (Video)Anthony Brune III; Hemant Parmar; Sandra Camelo-Piragua; Lindsey De LottA 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...
92 Not All Men With Thick Skulls Have High Testosterone (Video)Prem SubramanianA 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...
93 You're Too Young for That! (PDF)Sravanthi Vegunta; Kathleen Digre; Bradley Katz; Meagan Seay; Alison Crum; Edward Quigley; Sean Kennedy; Nick Mamalis; Judith WarnerAn 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...
94 You're Too Young for That! (Video)Sravanthi Vegunta; Kathleen Digre; Bradley Katz; Meagan Seay; Alison Crum; Edward Quigley; Sean Kennedy; Nick Mamalis; Judith WarnerAn 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...
95 Tissue Is the Issue (Slides)Christine Greer; Jasmine Francis; Eli Diamond; Charles Eberhart; Marc DinkinThe pathologic specimen demonstrated atypical histiocytic proliferation and infiltration with abundant cytoplasm, CD68+, S100+, consistent with Rosai Dorfman (RDD). The patient had been treated with steroids with a partial response and disease stabilization with radiation therapy with subsequent pro...
96 You're Too Young for That! (Slides)Sravanthi Vegunta; Kathleen Digre; Bradley Katz; Meagan Seay; Alison Crum; Edward Quigley; Sean Kennedy; Nick Mamalis; Judith WarnerAn 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...
97 Well Here Is Another Uveo-Meningeal Syndrome You Might Muck Up (Slides)David DeLeon; Mariel Rojas; Francisco Sanchez; Rosa Tang; Julie Patel; Jade SchiffmanA 16 y/o Caucasian female with a BMI of 24, went for an eye exam for blurry vision which corrected with refraction, however bilateral disc edema was found. There was a 4-year history of headaches that were intermittent and escalating in nature around 5 days a week, about 1 hour after awakening, and ...
98 Not All Men with Thick Skulls Have High Testosterone (Slides)Prem SubramanianA 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...
99 Well Here Is Another Uveo-Meningeal Syndrome You Might Muck Up (Video)David DeLeon; Mariel Rojas; Francisco Sanchez; Rosa Tang; Julie Patel; Jade SchiffmanA 16 y/o Caucasian female with a BMI of 24, went for an eye exam for blurry vision which corrected with refraction, however bilateral disc edema was found. There was a 4-year history of headaches that were intermittent and escalating in nature around 5 days a week, about 1 hour after awakening, and ...
100 Tissue Is the Issue (Video)Christine Greer; Jasmine Francis; Eli Diamond; Charles Eberhart; Marc DinkinThe pathologic specimen demonstrated atypical histiocytic proliferation and infiltration with abundant cytoplasm, CD68+, S100+, consistent with Rosai Dorfman (RDD). The patient had been treated with steroids with a partial response and disease stabilization with radiation therapy with subsequent pro...
101 Tissue Is the IssueChristine Greer; Jasmine Francis; Eli Diamond; Charles Eberhart; Marc DinkinThe pathologic specimen demonstrated atypical histiocytic proliferation and infiltration with abundant cytoplasm, CD68+, S100+, consistent with Rosai Dorfman (RDD). The patient had been treated with steroids with a partial response and disease stabilization with radiation therapy with subsequent pro...
102 Turbulence, Fluid Waves, and the Black HoleStella Chung; Daniel Rubinstein; Leon Rafailov; Nilo Toledo; Paul Langer; James Liu; Roger TurbinA 61-year old male developed an acute exacerbation superimposed on a 3-month relapsing and remitting course of painless eyelid swelling beginning in the right upper lid progressing to involve both upper and lower eyelids, malar area, and temporalis. He provided photographic documentation of dramatic...
103 Not the Rolling StonesAri Shemesh; Anthony Brune; Lilja Solnes; Avindra Nath; John Probasco; Daniel GoldA 68-year-old woman presented to the clinic complaining of "bouncing" vision when waking up at night for one month. Two years ago, she experienced discrete episodes of spinning for seconds provoked by head movements, which resolved spontaneously. Her ocular motor and vestibular exams were normal asi...
104 Just the Two of UsDan Milea; Pratik Chougule; Ming LeeA 63-year-old female patient of Chinese ethnicity was referred for unexplained visual loss in her right eye, discovered incidentally 1 month before presentation. Her past medical history revealed quiescent asthma and a benign cyst in the left lung, excised 27 years earlier. The patient had no vascul...
105 At the CrossroadsKonstantinos Douglas; Michael Yoon; Frederick Jakobiec; Joseph Rizzo III; Bart ChwaliszA 54-year-old female former smoker presented with vertical diplopia, left facial pain and left forehead weakness. She previously had thyroidectomy for a noncancerous nodule and abdominal hysterectomy for fibroids. She reported a two-year history of worsening facial pain and numbness that started as ...
106 Fooled ThriceJonathan Micieli; Hui-Kuo Shu; Alessandra Schmitt; Nancy NewmanA 40-year-old healthy man presented with a one-month history of left ptosis and binocular horizontal diplopia. Examination revealed normal afferent visual function. He had left ptosis and there was limitation of elevation, depression, adduction and a dilated, sluggishly reactive pupil in the left ey...
107 Just the Two of UsDan Milea; Pratik Chougule; Ming LeeA 63-year-old female patient of Chinese ethnicity was referred for unexplained visual loss in her right eye, discovered incidentally 1 month before presentation. Her past medical history revealed quiescent asthma and a benign cyst in the left lung, excised 27 years earlier. The patient had no vascul...
108 Every Rose Has Its ThornWilliam Anderson; Aseem Sharma; Miguel Guzman; Sophia ChungA 26-year-old woman presented with a one-year history of horizontal binocular diplopia on far-right gaze. During a routine eye examination for contact lenses, she was found to have a gaze paretic nystagmus on far-right gaze. The patient also offered a one-year history of right-sided instability and ...
109 Fooled ThriceJonathan Micieli; Hui-Kuo Shu; Alessandra Schmitt; Nancy NewmanA 40-year-old healthy man presented with a one-month history of left ptosis and binocular horizontal diplopia. Examination revealed normal afferent visual function. He had left ptosis and there was limitation of elevation, depression, adduction and a dilated, sluggishly reactive pupil in the left ey...
110 Every Rose Has Its ThornWilliam Anderson; Aseem Sharma; Miguel Guzman; Sophia ChungA 26-year-old woman presented with a one-year history of horizontal binocular diplopia on far-right gaze. During a routine eye examination for contact lenses, she was found to have a gaze paretic nystagmus on far-right gaze. The patient also offered a one-year history of right-sided instability and ...
111 Turbulence, Fluid Waves, and the Black HoleStella Chung; Daniel Rubinstein; Leon Rafailov; Nilo Toledo; Paul Langer; James Liu; Roger TurbinA 61-year old male developed an acute exacerbation superimposed on a 3-month relapsing and remitting course of painless eyelid swelling beginning in the right upper lid progressing to involve both upper and lower eyelids, malar area, and temporalis. He provided photographic documentation of dramatic...
112 At the CrossroadsKonstantinos Douglas; Michael Yoon; Frederick Jakobiec; Joseph Rizzo III; Bart ChwaliszA 54-year-old female former smoker presented with vertical diplopia, left facial pain and left forehead weakness. She previously had thyroidectomy for a noncancerous nodule and abdominal hysterectomy for fibroids. She reported a two-year history of worsening facial pain and numbness that started as ...
113 Not the Rolling StonesAri Shemesh; Anthony Brune; Lilja Solnes; Avindra Nath; John Probasco; Daniel GoldA 68-year-old woman presented to the clinic complaining of "bouncing" vision when waking up at night for one month. Two years ago, she experienced discrete episodes of spinning for seconds provoked by head movements, which resolved spontaneously. Her ocular motor and vestibular exams were normal asi...
114 Turbulence, Fluid Waves, and the Black HoleStella Chung; Daniel Rubinstein; Leon Rafailov; Nilo Toledo; Paul Langer; James Liu; Roger TurbinA 61-year old male developed an acute exacerbation superimposed on a 3-month relapsing and remitting course of painless eyelid swelling beginning in the right upper lid progressing to involve both upper and lower eyelids, malar area, and temporalis. He provided photographic documentation of dramatic...
115 Fooled ThriceJonathan Micieli; Hui-Kuo Shu; Alessandra Schmitt; Nancy NewmanA 40-year-old healthy man presented with a one-month history of left ptosis and binocular horizontal diplopia. Examination revealed normal afferent visual function. He had left ptosis and there was limitation of elevation, depression, adduction and a dilated, sluggishly reactive pupil in the left ey...
116 At the CrossroadsKonstantinos Douglas; Michael Yoon; Frederick Jakobiec; Joseph Rizzo III; Bart ChwaliszA 54-year-old female former smoker presented with vertical diplopia, left facial pain and left forehead weakness. She previously had thyroidectomy for a noncancerous nodule and abdominal hysterectomy for fibroids. She reported a two-year history of worsening facial pain and numbness that started as ...
117 Every Rose Has Its ThornWilliam Anderson; Aseem Sharma; Miguel Guzman; Sophia ChungA 26-year-old woman presented with a one-year history of horizontal binocular diplopia on far-right gaze. During a routine eye examination for contact lenses, she was found to have a gaze paretic nystagmus on far-right gaze. The patient also offered a one-year history of right-sided instability and ...
118 Just the Two of UsDan Milea; Pratik Chougule; Ming LeeA 63-year-old female patient of Chinese ethnicity was referred for unexplained visual loss in her right eye, discovered incidentally 1 month before presentation. Her past medical history revealed quiescent asthma and a benign cyst in the left lung, excised 27 years earlier. The patient had no vascul...
119 A Zebra Among ZebrasPeter Mortensen; Gabrielle Bonhomme61-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...
120 Go With Your Gut FeelingPaul Freund; Ari Shemesh; Gabriella Mankovskii; Ana Pejovic-Milic; David Howarth; Edward Margolin71 year-old man noticed a "smudge" in his central vision when reading that was gradually progressing over a year. Medical history was significant for one episode of hemorrhagic colitis requiring colectomy 28 years ago diagnosed as Crohn's disease, atrial fibrillation, and congenital dyschromatopsia....
121 A-deno What's Going On!Christine Greer; Salina Teja; Jennifer Danesch; Anna Mathew; Vivek Patel; Kimberly GokoffskiA 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...
122 Go With Your Gut FeelingPaul Freund; Ari Shemesh; Gabriella Mankovskii; Ana Pejovic-Milic; David Howarth; Edward Margolin71 year-old man noticed a "smudge" in his central vision when reading that was gradually progressing over a year. Medical history was significant for one episode of hemorrhagic colitis requiring colectomy 28 years ago diagnosed as Crohn's disease, atrial fibrillation, and congenital dyschromatopsia....
123 A-deno What's Going On!Christine Greer; Salina Teja; Jennifer Danesch; Anna Mathew; Vivek Patel; Kimberly GokoffskiA 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...
124 A Zebra Among ZebrasPeter Mortensen; Gabrielle Bonhomme61-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...
125 The Great MasqueradeBart Chwalisz; Dean CestariA 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...
126 Chalky Pallid EdemaDaniel Kornberg; David Pisapia; Cynthia Magro; Cristiano Oliveira; Marc DinkinA 52 year-old woman with hypertension, insulin dependent type II diabetes, mild non-proliferative diabetic retinopathy in both eyes, obstructive sleep apnea, paroxysmal atrial fibrillation, obesity and multifactorial end-stage renal disease (ESRD) complained of four days of a dark scotoma in the inf...
127 The Great MasqueradeBart Chwalisz; Dean CestariA 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...
128 Chalky Pallid EdemaDaniel Kornberg; David Pisapia; Cynthia Magro; Cristiano Oliveira; Marc DinkinA 52 year-old woman with hypertension, insulin dependent type II diabetes, mild non-proliferative diabetic retinopathy in both eyes, obstructive sleep apnea, paroxysmal atrial fibrillation, obesity and multifactorial end-stage renal disease (ESRD) complained of four days of a dark scotoma in the inf...
129 Chalky Pallid EdemaDaniel Kornberg; David Pisapia; Cynthia Magro; Cristiano Oliveira; Marc DinkinA 52 year-old woman with hypertension, insulin dependent type II diabetes, mild non-proliferative diabetic retinopathy in both eyes, obstructive sleep apnea, paroxysmal atrial fibrillation, obesity and multifactorial end-stage renal disease (ESRD) complained of four days of a dark scotoma in the inf...
130 Go With Your Gut FeelingPaul Freund; Ari Shemesh; Gabriella Mankovskii; Ana Pejovic-Milic; David Howarth; Edward Margolin71 year-old man noticed a "smudge" in his central vision when reading that was gradually progressing over a year. Medical history was significant for one episode of hemorrhagic colitis requiring colectomy 28 years ago diagnosed as Crohn's disease, atrial fibrillation, and congenital dyschromatopsia....
131 A Zebra Among Zebras (Slides)Peter Mortensen; Gabrielle Bonhomme61-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...
132 The Great MasqueradeBart Chwalisz; Dean CestariA 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...
133 A-deno What's Going On!Christine Greer; Salina Teja; Jennifer Danesch; Anna Mathew; Vivek Patel; Kimberly GokoffskiA 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...
134 Unexplained Becomes ExplainedJinu Han; Hye Young Kim; Sueng-Han Han7 years old male presented to the ophthalmology clinic for the evaluation of low vision. He was born with caesarean section after an uneventful pregnancy at 38 weeks, 4.05kg. The mother denied any perinatal hypoxia, ischemia or head injury during delivery. He first visited pediatric neurology clinic...
135 Don't Drink the WaterDevon Cohen; Muhammad Bhatti; John ChenA 19-year-old right-handed man presented with a 3 year history of episodic headaches, right hemiparesis, and progressive vision loss OU. Beginning in the fall of 2015, he developed stepwise deterioration in vision OU in association with severe headaches. Initial evaluation at an outside hospital sho...
136 Unexplained Becomes ExplainedJinu Han; Hye Young Kim; Sueng-Han Han7 years old male presented to the ophthalmology clinic for the evaluation of low vision. He was born with caesarean section after an uneventful pregnancy at 38 weeks, 4.05kg. The mother denied any perinatal hypoxia, ischemia or head injury during delivery. He first visited pediatric neurology clinic...
137 A Trip Through the WormholeAnne KaoThe 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...
138 A Trip Through the WormholeAnne KaoThe 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...
139 Fire and IceMary Maher; Joah Aliancy; Gul Moonis; Angela Lignelli; Michael Kazim; Jeffrey OdelA 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 ...
140 Fire and IceMary Maher; Joah Aliancy; Gul Moonis; Angela Lignelli; Michael Kazim; Jeffrey OdelA 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 ...
141 Don't Drink the WaterDevon Cohen; Muhammad Bhatti; John ChenA 19-year-old right-handed man presented with a 3 year history of episodic headaches, right hemiparesis, and progressive vision loss OU. Beginning in the fall of 2015, he developed stepwise deterioration in vision OU in association with severe headaches. Initial evaluation at an outside hospital sho...
142 Unexplained Becomes ExplainedJinu Han; Hye Young Kim; Sueng-Han Han7 years old male presented to the ophthalmology clinic for the evaluation of low vision. He was born with caesarean section after an uneventful pregnancy at 38 weeks, 4.05kg. The mother denied any perinatal hypoxia, ischemia or head injury during delivery. He first visited pediatric neurology clinic...
143 Three's a CrowdKanwal Matharu; Veeral ShahA 2 year-old male boy was referred for painless, progressive proptosis in the right eye over a one year. The patient had no history of trauma, personal or family history of malignancy, or orbital inflammation, and had an unremarkable past medical history. On exam, the patient had fix and follow visi...
144 A Trip Through the WormholeAnne KaoThe 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...
145 Fire and IceMary Maher; Joah Aliancy; Gul Moonis; Angela Lignelli; Michael Kazim; Jeffrey OdelA 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 ...
146 Don't Drink the WaterDevon Cohen; Muhammad Bhatti; John ChenA 19-year-old right-handed man presented with a 3 year history of episodic headaches, right hemiparesis, and progressive vision loss OU. Beginning in the fall of 2015, he developed stepwise deterioration in vision OU in association with severe headaches. Initial evaluation at an outside hospital sho...
147 Three's a CrowdKanwal Matharu; Veeral ShahA 2 year-old male boy was referred for painless, progressive proptosis in the right eye over a one year. The patient had no history of trauma, personal or family history of malignancy, or orbital inflammation, and had an unremarkable past medical history. On exam, the patient had fix and follow visi...
148 Three's a CrowdKanwal Matharu; Veeral ShahA 2 year-old male boy was referred for painless, progressive proptosis in the right eye over a one year. The patient had no history of trauma, personal or family history of malignancy, or orbital inflammation, and had an unremarkable past medical history. On exam, the patient had fix and follow visi...
149 Cold Fever - SlidesShannon BeresA 34-year old rock-climbing-mountain man woke with bilateral painless blurry vision along with alternating conjunctival erythema and eyelid edema. A headache began without associated migrainous features. Prior history revealed an untreated mysterious ‘new form of TB' followed by the CDC at age 2 d...
150 Light at the End of the Tunnel - SlidesNoel Chan; Tak Lap Poon; Joyce Chow; Wai Lun Poon; Sherman Lo; Wing Hung Lau; Ka Hong Au; Carmen ChanA 24-year-old Chinese man presented with 1-year history of progressive blurring of vision of the right eye. He had no significant past ocular nor medical history except moderate myopia and migraine. On ophthalmologic examination, his corrected visual acuity at distance was 20/100 OD and 20/30 OS. Is...
151 It's Always Been Like That - SlidesEric Gaier; William Butler; Joseph RizzoAn 18 year-old Caucasian boy presented with left upper eyelid ptosis, headaches, and iris heterochromia. The patient and his family reported the left iris being darker than the right since early childhood. Over the 5 years preceding his presentation, the patient's mother noted progressive ptosis of ...
152 Coming to a Rapid Conclusion - SlidesLeanne Stunkel; Namita Sinha; Nathan Kung; Robi Maamari; Cole Ferguson; Sonika Dahiya; George Harocopos; Gregory Van StavernA 21-year-old man presented to a retina specialist for 2.5 weeks of painless central vision loss OD. His initial examination was notable for visual acuity 20/200 OD and 20/20 OS. Fundus examination was significant for several macular areas of retinal pigment epithelial (RPE) atrophy with associated ...
153 A Can of Worms - SlidesAli Hamedani; Madhura TamhankarA 67 year-old man presented to the ophthalmology clinic with one day of binocular horizontal diplopia. He also complained of one week of bilateral periorbital pain which was worse on the right than the left. Four days prior, he had undergone partial right nephrectomy for grade II papillary renal cel...
154 A Tough Nut to Crack! - SlidesLauren Maloley; Sachin Kedar; Deepta Ghate; Dominick DiMaio; Jason Helvey; Sachin KedarA 47-year-old previously healthy female was transferred to our facility when she developed left abducens nerve palsy during treatment of intractable sinusitis. Two weeks prior to presentation, she developed headache and sinus congestion. She was treated with amoxicillin-clavulanic acid and prednison...
155 Lumps and Bumps - SlidesWayne Tie; Martha SchatzA 37 year-old man with no PMH presented with bilateral painful red eyes and progressive proptosis for several months. He noted the increasing protrusion of both eyes, but only complained of recent onset of pain in both eyes over the last four days. He also developed worsening blurry vision in both e...
156 Whipping Up a New Flavor - SlidesMeagan Seay; Tory Johnson; Benjamin Larman; Avindra Nath; Myoung-Hwa Lee; Janet Rucker; Jonathan Howard; Ilya Kister; Matija Snuderl; Laura Balcer; Steven GalettaA 43-year old Indian man presented with two years of progressive gait imbalance, dysarthria, and cognitive decline. Neurological exam revealed supranuclear gaze palsy with impaired downgaze and loss of OKN quick phases, impaired horizontal pursuit, ideomotor apraxia, facial and arm dystonia, foot an...
157 What Don't You See? - SlidesJames O'Brien; R. Michael SiatkowskiA four-year old male presented for evaluation of abnormal eye movements and strabismus which had been present since approximately 6 weeks of age. He was previously diagnosed with nystagmus, ocular torticollis, and esotropia by another provider. An MRI of the brain was performed at approximately 4 we...
158 Gee...What's Causing that Pap? - SlidesSusan Mollan; Daniel White; Santhosh Nagaraju; Swarupsinh Chavda; Tom Hayton; Saiju JacobA 36 year old woman presented with history of Myasthenia Gravis (MG) since the age of 18. She was known to have dry eyes and hypothyroidism. Past surgical history included a thymectomy (age 23 years). The MG had been difficult to control with past medications including corticosteroids, azathioprine,...
159 Triple Take - SlidesJohanna Beebe, Liang Cheng, Shira Simon, Michael Wall, Randy Kardon, Alkapalan Deema, Ian Han, Matthew ThurtellA 42 year-old male noticed difficulty reading labels while stocking shelves at work. Over the next three weeks, he developed a dark 'cloud' in his central vision in the left eye, and then the right eye. He did not have associated pain. When evaluated by the retina service, his visual acuities were 2...
160 A Sad Story - SlidesJason PeragalloA 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...
161 When the Problem Becomes the Solution - SlidesAri Shemesh; Timo Krings; Dalia Rotstein; David Munoz; Waleed Brinjikji; Laila Al Shafai; Edward Margolin25 year-old man noticed slow progressive decrease in vision in left eye. Vision was 20/20 OD and 20/40 OS, there was swelling of left optic nerve head. MRI demonstrated white matter lesions in left frontal lobe; cerebrospinal fluid composition was normal. Patient was seen in MS clinic and treatment ...
162 Testing the Hypophysis - SlidesAlberto Distefano; Julie Cho; Adeniyi Fisayo; Mahsa SohrabA 60 year-old female with history of hypertension, hyperlipidemia, and Lyme disease 12 years ago treated with doxycycline, developed extreme thirst and polyuria four years ago and was diagnosed with central diabetes insipidus. Magnetic resonance imaging (MRI) at that time showed enhancement of the p...
163 One Peak is Worth Twenty Finesses - SlidesSteven Newman; James MandellAn 8 year old was referred with a one week history of swelling around her left eye. She was not aware of any change in her vision or double vision. Visual acuity was 20/20 OD and 20/25 OS. Visual fields demonstrated minimal scattered desaturation with < ½ dB asymmetry between the two sides. Externa...
164 A Giant (Cell) Mistake - SlidesBehzad Mansouri; Paul Wawryko; Frank Bovell71-year-old, left-handed woman, who was referred with ptosis, loss of vision in the right eye and headache. In July 2015 she presented to ER with severe right temporal headache and watery right eye. Her exam and head CT was normal. Her ESR/CRP were elevated. She was allegedly diagnosed with GCA and ...
165 Coming to a Rapid Conclusion - AbstractLeanne Stunkel; Namita Sinha; Nathan Kung; Robi Maamari; Cole Ferguson; Sonika Dahiya; George Harocopos; Gregory Van StavernA 21-year-old man presented to a retina specialist for 2.5 weeks of painless central vision loss OD. His initial examination was notable for visual acuity 20/200 OD and 20/20 OS. Fundus examination was significant for several macular areas of retinal pigment epithelial (RPE) atrophy with associated ...
166 Coming to a Rapid Conclusion - VideoLeanne Stunkel; Namita Sinha; Nathan Kung; Robi Maamari; Cole Ferguson; Sonika Dahiya; George Harocopos; Gregory Van StavernA 21-year-old man presented to a retina specialist for 2.5 weeks of painless central vision loss OD. His initial examination was notable for visual acuity 20/200 OD and 20/20 OS. Fundus examination was significant for several macular areas of retinal pigment epithelial (RPE) atrophy with associated ...
167 A Can of Worms - AbstractAli Hamedani; Madhura TamhankarA 67 year-old man presented to the ophthalmology clinic with one day of binocular horizontal diplopia. He also complained of one week of bilateral periorbital pain which was worse on the right than the left. Four days prior, he had undergone partial right nephrectomy for grade II papillary renal cel...
168 A Can of Worms - VideoAli Hamedani; Madhura TamhankarA 67 year-old man presented to the ophthalmology clinic with one day of binocular horizontal diplopia. He also complained of one week of bilateral periorbital pain which was worse on the right than the left. Four days prior, he had undergone partial right nephrectomy for grade II papillary renal cel...
169 It's Always Been Like That - VideoEric Gaier; William Butler; Joseph RizzoAn 18 year-old Caucasian boy presented with left upper eyelid ptosis, headaches, and iris heterochromia. The patient and his family reported the left iris being darker than the right since early childhood. Over the 5 years preceding his presentation, the patient's mother noted progressive ptosis of ...
170 Cold Fever - VideoShannon BeresA 34-year old rock-climbing-mountain man woke with bilateral painless blurry vision along with alternating conjunctival erythema and eyelid edema. A headache began without associated migrainous features. Prior history revealed an untreated mysterious ‘new form of TB' followed by the CDC at age 2 d...
171 It's Always Been Like That - AbstractEric Gaier; William Butler; Joseph RizzoAn 18 year-old Caucasian boy presented with left upper eyelid ptosis, headaches, and iris heterochromia. The patient and his family reported the left iris being darker than the right since early childhood. Over the 5 years preceding his presentation, the patient's mother noted progressive ptosis of ...
172 Cold Fever - AbstractShannon BeresA 34-year old rock-climbing-mountain man woke with bilateral painless blurry vision along with alternating conjunctival erythema and eyelid edema. A headache began without associated migrainous features. Prior history revealed an untreated mysterious ‘new form of TB' followed by the CDC at age 2 d...
173 Light at the End of the Tunnel - VideoNoel Chan; Tak Lap Poon; Joyce Chow; Wai Lun Poon; Sherman Lo; Wing Hung Lau; Ka Hong Au; Carmen ChanA 24-year-old Chinese man presented with 1-year history of progressive blurring of vision of the right eye. He had no significant past ocular nor medical history except moderate myopia and migraine. On ophthalmologic examination, his corrected visual acuity at distance was 20/100 OD and 20/30 OS. Is...
174 Light at the End of the Tunnel - AbstractNoel Chan; Tak Lap Poon; Joyce Chow; Wai Lun Poon; Sherman Lo; Wing Hung Lau; Ka Hong Au; Carmen ChanA 24-year-old Chinese man presented with 1-year history of progressive blurring of vision of the right eye. He had no significant past ocular nor medical history except moderate myopia and migraine. On ophthalmologic examination, his corrected visual acuity at distance was 20/100 OD and 20/30 OS. Is...
175 A Tough Nut to Crack! - AbstractLauren Maloley; Sachin Kedar; Deepta Ghate; Dominick DiMaio; Jason Helvey; Sachin KedarA 47-year-old previously healthy female was transferred to our facility when she developed left abducens nerve palsy during treatment of intractable sinusitis. Two weeks prior to presentation, she developed headache and sinus congestion. She was treated with amoxicillin-clavulanic acid and prednison...
176 Lumps and Bumps - VideoWayne Tie; Martha SchatzA 37 year-old man with no PMH presented with bilateral painful red eyes and progressive proptosis for several months. He noted the increasing protrusion of both eyes, but only complained of recent onset of pain in both eyes over the last four days. He also developed worsening blurry vision in both e...
177 Gee...What's Causing that Pap? - VideoSusan Mollan; Daniel White; Santhosh Nagaraju; Swarupsinh Chavda; Tom Hayton; Saiju JacobA 36 year old woman presented with history of Myasthenia Gravis (MG) since the age of 18. She was known to have dry eyes and hypothyroidism. Past surgical history included a thymectomy (age 23 years). The MG had been difficult to control with past medications including corticosteroids, azathioprine,...
178 Whipping Up a New Flavor - AbstractMeagan Seay; Tory Johnson; Benjamin Larman; Avindra Nath; Myoung-Hwa Lee; Janet Rucker; Jonathan Howard; Ilya Kister; Matija Snuderl; Laura Balcer; Steven GalettaA 43-year old Indian man presented with two years of progressive gait imbalance, dysarthria, and cognitive decline. Neurological exam revealed supranuclear gaze palsy with impaired downgaze and loss of OKN quick phases, impaired horizontal pursuit, ideomotor apraxia, facial and arm dystonia, foot an...
179 A Tough Nut to Crack! - VideoLauren Maloley; Sachin Kedar; Deepta Ghate; Dominick DiMaio; Jason Helvey; Sachin KedarA 47-year-old previously healthy female was transferred to our facility when she developed left abducens nerve palsy during treatment of intractable sinusitis. Two weeks prior to presentation, she developed headache and sinus congestion. She was treated with amoxicillin-clavulanic acid and prednison...
180 Lumps and Bumps - AbstractWayne Tie; Martha SchatzA 37 year-old man with no PMH presented with bilateral painful red eyes and progressive proptosis for several months. He noted the increasing protrusion of both eyes, but only complained of recent onset of pain in both eyes over the last four days. He also developed worsening blurry vision in both e...
181 Gee...What's Causing that Pap? - AbstractSusan Mollan; Daniel White; Santhosh Nagaraju; Swarupsinh Chavda; Tom Hayton; Saiju JacobA 36 year old woman presented with history of Myasthenia Gravis (MG) since the age of 18. She was known to have dry eyes and hypothyroidism. Past surgical history included a thymectomy (age 23 years). The MG had been difficult to control with past medications including corticosteroids, azathioprine,...
182 What Don't You See? - AbstractJames O'Brien; R. Michael SiatkowskiA four-year old male presented for evaluation of abnormal eye movements and strabismus which had been present since approximately 6 weeks of age. He was previously diagnosed with nystagmus, ocular torticollis, and esotropia by another provider. An MRI of the brain was performed at approximately 4 we...
183 What Don't You See? - VideoJames O'Brien; R. Michael SiatkowskiA four-year old male presented for evaluation of abnormal eye movements and strabismus which had been present since approximately 6 weeks of age. He was previously diagnosed with nystagmus, ocular torticollis, and esotropia by another provider. An MRI of the brain was performed at approximately 4 we...
184 Whipping Up a New Flavor - VideoMeagan Seay; Tory Johnson; Benjamin Larman; Avindra Nath; Myoung-Hwa Lee; Janet Rucker; Jonathan Howard; Ilya Kister; Matija Snuderl; Laura Balcer; Steven GalettaA 43-year old Indian man presented with two years of progressive gait imbalance, dysarthria, and cognitive decline. Neurological exam revealed supranuclear gaze palsy with impaired downgaze and loss of OKN quick phases, impaired horizontal pursuit, ideomotor apraxia, facial and arm dystonia, foot an...
185 When the Problem Becomes the Solution - AbstractAri Shemesh; Timo Krings; Dalia Rotstein; David Munoz; Waleed Brinjikji; Laila Al Shafai; Edward Margolin25 year-old man noticed slow progressive decrease in vision in left eye. Vision was 20/20 OD and 20/40 OS, there was swelling of left optic nerve head. MRI demonstrated white matter lesions in left frontal lobe; cerebrospinal fluid composition was normal. Patient was seen in MS clinic and treatment ...
186 Testing the Hypophysis - VideoAlberto Distefano; Julie Cho; Adeniyi Fisayo; Mahsa SohrabA 60 year-old female with history of hypertension, hyperlipidemia, and Lyme disease 12 years ago treated with doxycycline, developed extreme thirst and polyuria four years ago and was diagnosed with central diabetes insipidus. Magnetic resonance imaging (MRI) at that time showed enhancement of the p...
187 A Sad Story - VideoJason PeragalloA 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...
188 Testing the Hypophysis - AbstractAlberto Distefano; Julie Cho; Adeniyi Fisayo; Mahsa SohrabA 60 year-old female with history of hypertension, hyperlipidemia, and Lyme disease 12 years ago treated with doxycycline, developed extreme thirst and polyuria four years ago and was diagnosed with central diabetes insipidus. Magnetic resonance imaging (MRI) at that time showed enhancement of the p...
189 One Peak is Worth Twenty Finesses - AbstractSteven Newman; James MandellAn 8 year old was referred with a one week history of swelling around her left eye. She was not aware of any change in her vision or double vision. Visual acuity was 20/20 OD and 20/25 OS. Visual fields demonstrated minimal scattered desaturation with < ½ dB asymmetry between the two sides. Externa...
190 A Sad Story - AbstractJason PeragalloA 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...
191 Triple Take - AbstractJohanna Beebe; Liang Cheng; Shira Simon; Michael Wall; Randy Kardon; Alkapalan Deema; Ian Han; Matthew ThurtellA 42 year-old male noticed difficulty reading labels while stocking shelves at work. Over the next three weeks, he developed a dark 'cloud' in his central vision in the left eye, and then the right eye. He did not have associated pain. When evaluated by the retina service, his visual acuities were 2...
192 Triple Take - VideoJohanna Beebe; Liang Cheng; Shira Simon; Michael Wall; Randy Kardon; Alkapalan Deema; Ian Han; Matthew ThurtellA 42 year-old male noticed difficulty reading labels while stocking shelves at work. Over the next three weeks, he developed a dark 'cloud' in his central vision in the left eye, and then the right eye. He did not have associated pain. When evaluated by the retina service, his visual acuities were 2...
193 When the Problem Becomes the Solution - VideoAri Shemesh; Timo Krings; Dalia Rotstein; David Munoz; Waleed Brinjikji; Laila Al Shafai; Edward Margolin25 year-old man noticed slow progressive decrease in vision in left eye. Vision was 20/20 OD and 20/40 OS, there was swelling of left optic nerve head. MRI demonstrated white matter lesions in left frontal lobe; cerebrospinal fluid composition was normal. Patient was seen in MS clinic and treatment ...
194 A Giant (Cell) Mistake - VideoBehzad Mansouri; Paul Wawryko; Frank Bovell71-year-old, left-handed woman, who was referred with ptosis, loss of vision in the right eye and headache. In July 2015 she presented to ER with severe right temporal headache and watery right eye. Her exam and head CT was normal. Her ESR/CRP were elevated. She was allegedly diagnosed with GCA and ...
195 A Giant (Cell) Mistake - AbstractBehzad Mansouri; Paul Wawryko; Frank Bovell71-year-old, left-handed woman, who was referred with ptosis, loss of vision in the right eye and headache. In July 2015 she presented to ER with severe right temporal headache and watery right eye. Her exam and head CT was normal. Her ESR/CRP were elevated. She was allegedly diagnosed with GCA and ...
196 One Peak is Worth Twenty Finesses - VideoSteven Newman; James MandellAn 8 year old was referred with a one week history of swelling around her left eye. She was not aware of any change in her vision or double vision. Visual acuity was 20/20 OD and 20/25 OS. Visual fields demonstrated minimal scattered desaturation with < ½ dB asymmetry between the two sides. Externa...
197 Lions and Tigers and Bears, Oh My! (abstract)Larissa Ghadiali; Danlin Mao; Gul Moonis; Adam Sonabend; Catherine Shu; Terri Kreisl; Esther Coronel; Jeffrey OdelA 79 year-old female s/p resection of a right CPA meningioma in 1998 noted sudden painless visual loss OD on 6-12-2016. Two days later examination revealed 20/150 vision OD, a right RAPD, and an otherwise normal ophthalmic exam.
198 Not Surprised Surprise (video)Yu Zhao; Joshua Pasol; Sander Dubovy; Byron LamA 68-year-old Hispanic woman presented to our emergency department with significant vision loss OS for 1 week. A month ago, she was evaluated locally for mild blurry vision OS, and corrected acuity was 20/30 OD, 20/40 OS. She was diagnosed with cataracts and epiretinal membrane OD. Medical history i...
199 A Wrong Turn at the Angle (abstract)Erica Archer; Jonathan Trobe; Hemant Parmar; Mohannad Ibrahim; Paul McKeever; Thomas GiordanoA 54-year-old woman developed numbness of the right jaw and right side of the tongue. She attributed her symptomatology to recent dental work, but when dental examination, including dental x-rays, failed to reveal an answer, she underwent brain MRI.
200 Strike a Chord (video)Anastasia Neufeld; Kathleen Digre; Cheryl Palmer; H. Christian Davidson; Alison Crum; Bradley Katz; Judith WarnerA 26 year old woman presented in August 2016 with migraine over the last 4 years, getting worse over the last 2 weeks. She reported occasional 'glittering' in her vision in both eyes. She had no constitutional symptoms. Her past medical history included migraine, idiopathic leukocytosis, and nephrol...
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