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1 Crowded Disc - FamilyWilliam F. Hoyt, PhDLeft eye. PP3 a & b: sister; PP4 a&b: brother; Congenital disc margin blurring with crowded discs. Excellent example of pseudo papilledema. Pathology: Normal variation of the optic disc. Disease/Diagnosis: Normal variation of the optic disc. Crowded disc. Clinical notes: Appearance due to too many f...Pseudopapilledema; Congenital Blurred Disc
2 Optic Atrophy (PowerPoint)William F. Hoyt, PhDa) Evolution of optic disc pallor after optic nerve transection. Normal Right eye. Photo taken December 9, 1978. b) Injury on December 8, 1978. Evolution of optic disc pallor after optic nerve transection. Woman having rhinoplasty suffered optic nerve transection. One day after nerve transection. N...Optic Disc Atrophy from Retrobulbar Causes (Retrograde Optic Nerve Degeneration); Severe Atrophy; Optic Atrophic
3 Temporal Atrophy (PowerPoint)William F. Hoyt, PhDSegmental Atrophy - Temporal pallor - Nutritional amblyopia (alcoholic). 1985.Temporal Atrophy; Optic Disc Atrophy from Retrobulbar Causes (Retrograde Optic Nerve Degeneration); Severe Atrophy; Alcohol
4 Oculocephalic Reflex AnimationSuzanne S. Stensaas, PhD; Quentin RoperAnimation describing the vestibuloocular reflex.Vestibuloocular Reflex; Vestibular Ocular System
5 Central/Branch Retinal Artery Occlusion (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyOcclusion of a branch or central retinal artery may result in acute visual loss. The ophthalmoscopic findings are retinal whitening due to ischemic retina in the distribution of the occluded artery. Sparing or selective involvement of cilioretinal artery branches may occur. Patients with a central r...Central/Branch Retinal Artery Occlusion
6 Chest CT Thymoma (Guest Lecture)Robert A. Novelline, MDThe patient is a 46 year old woman who presented in July 1977 with horizontal double vision lasting two weeks. Three weeks later the left upper eyelid started to droop and by the end of the day the eye was closed. She had no ptosis of the right eye and no generalized fatigue. She consulted an intern...Unilateral Ptosis; Unilateral Lid Retraction; Myasthenic Lid Twitch; External Ophthalmoplegia; Ocular Myasthenia Gravis; Tensilon Test; Thymolipoma; Generalized Myasthenia Gravis; Unilateral Myasthenia Gravis; Myasthenic Ptosis; Lid Retraction; Lid Twitch
7 Chiasmal Herniation (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis woman was 61 years old when she underwent initial neuro-ophthalmologic evaluation. Twenty-three years earlier, she had undergone removal of a pituitary adenoma followed by radiation therapy. At that time, she had noted a preoperative visual field defect that improved somewhat after the surgery....Chiasmal Herniation
8 Paraneoplastic Disease (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 46-year-old woman noted progressive bilateral visual loss over a 10-month period. She had a malignant melanoma removed from her right thigh 2 years ago and excisional biopsy of an inguinal node metastasis 8 months ago. She also complained of poor night vision and rare intermittent ""sparkles"" ...Paraneoplastic Disease
9 Evolution of Optociliary Veins with Perioptic Nerve SheathWilliam F. Hoyt, PhDSeries of images showing progression of disc swelling and macular degeneration. Pathology: Optociliary Vein. Disease/Diagnosis: Perioptic nerve sheath meningioma evolution. Clinical notes: Visual Loss.Optic Disc Atrophy with Special Features; Optociliary Veins; Shunt Vessels (Meningioma)
10 Exposed Drusen (PowerPoint)William F. Hoyt, PhDPP25a: Left eye: Severe visual field defect. PP25b: right eye with exposed drusen and field loss: visual field defects; PP25c: right eye visual field PP25d: left eye visual field.Pseudopapilledema; Exposed Drusen
11 Brain MRI in Multiple Sclerosis (Guest Lecture)Anne G. Osborn, MDThe patient is a 25 year old woman who was in excellent health until 4 days prior to admission when she noted blurred vision and horizontal double vision on lateral gaze to right and left. Past History: Negative for strabismus as a child. No previous episodes of transient neurological symptoms. Fami...Bilateral Internuclear Ophthalmoplegia; Abducting Nystagmus; Normal Convergence; Gaze Evoked Upbeat Nystagmus; Gaze Evoked Downbeat Nystagmus; Saccadic Dysmetria; Multiple Sclerosis; Horizontal Saccadic Dysmetria
12 Pendular Vertical OscillationsShirley H. Wray, MD, PhD, FRCPSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/68, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/247, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/111, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/312, http://content.lib.utah.edu/cdm/ref...Palatal Tremor (Myoclonus); Pendular Vertical Oscillations; Unilateral Horizontal Gaze Palsy; Facial Palsy; Pontine Infarct; Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillain-Mollaret Triangle; Oculopalatal Myoclonus; Oculopalatal Tremor Lid Nystagmus; Bilater...
13 Paraneoplastic Upbeat NystagmusShirley H. Wray, MD, PhD, FRCPThis case was presented to the Clinical Eye Movement Society at the American Neurological Association Meeting in October 2009. The patient is a 65 year old woman who was in good health until seven weeks prior to admission. On June 22/09 on the return flight from her daughter's wedding in Oregon she ...Upbeat Nystagmus; Lid Nystagmus; Square Wave Jerks (Saccadic Oscillations); Saccadic Dysmetria; Saccadic Pursuit; Paraneoplastic Syndrome; Paraneoplastic Upbeat Nystagmus; Pancreatic Endocrine Carcinoma; Anti-Hu - Associated Paraneoplastic Encephalitis
14 Third Nerve PalsyShirley H. Wray, MD, PhD, FRCPThe patient is a 50 year old man with Type II Diabetes who presented to an outside hospital in September 1996 with ptosis and an inability to open the right eye. Five months prior to admission (PTA), he had flu-like symptoms with mild fever, sinus congestion and diffuse myalgia in the chest, abdomen...Ptosis; Unilateral Third Nerve Palsy; Oculomotor Nerve; Meningovascular Syphilis; Heubner's Arteritis; Unilateral Oculomotor Third Nerve Palsy; Third Nerve Microinfarct; Fascicular Third Nerve Palsy
15 Oculomasticatory MyorhythmiaShirley H. Wray, MD, PhD, FRCPThis case, previously reported in 1986, is published courtesy of John Selhorst, M.D., Saint Louis University School of Medicine, St. Louis, MO. (4) The patient is a 46 year old man who, over a period of six months, lost the ability to read and complained of excessive somnolence, occasional urinary i...Somnolence; Supranuclear Paralysis of Up and Downgaze; Pendular Vergence Oscillations; Oculomasticatory Myorhythmia; Tropheryma Whippelii - Infection; CNS Whipple's Disease; Supranuclear Paralysis of Up and Downgaze Infection-Whipple's Disease; Oculomasticatory Myorhythmia (Whipple's)
16 Familial Amyotrophic Lateral SclerosisShirley H. Wray, MD, PhD, FRCPThis 58 year old woman was referred to Dr. Robert Brown in March 1995 for evaluation of slurred speech. She remained under his care until her death. On examination she had signs of a pseudobulbar palsy: Dysarthria and dysphagia Diminished palatal movement with positive gag bilaterally Diminished rap...Supranuclear Paralysis of Up and Downgaze Degeneration; Convergence Insufficiency; Slow Hypometric Horizontal Saccades;; Saccadic Breakdown of Horizontal Pursuit; Bulbar Palsy; Familial Amyotrophic Lateral Sclerosis; Lou Gehrig's Disease; CNS -Degeneration; Superoxide Dismutase (SOD1) Gene
17 One and a Half SyndromeShirley H. Wray, MD, PhD, FRCPThis 44 year old woman presented in 1973 with an acute attack of optic neuritis in the right eye that fully recovered after a course of ACTH therapy. In 1991, 18 years later, she developed unsteadiness of gait, "walking like a chicken", stiff legs that jerked spontaneously in bed at night, and numbn...Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Fisher's One-and-a-Half Syndrome; Uhthoff's Symptom; Multiple Sclerosis; Unilateral Horizontal Gaze Palsy Demyelination; Gaze Evoked Upbeat Nystagmus; Abducting Nystagmus
18 Hemifacial SpasmShirley H. Wray, MD, PhD, FRCPThe patient is a 72 year old man with myopia, childhood exotropia, progressive age related ptosis and right hemifacial spasm. Hemifacial spasm (HS) most often begins insidiously in the orbicularis oculi muscle in the early stages, as in this man. He presented with a 2 year history of involuntary twi...Lid Twitch; Hemifacial Spasm; Neurovascular Compression Syndrome of the Facial Nerve
19 Pendular OscillationsShirley H. Wray, MD, PhD, FRCPThis 37 year old woman has had progressive multiple sclerosis (MS) affecting the cerebellum and brainstem for 6 years. Neurological examination: Titubation Dysarthria Incoordination of the extremities Ataxic gait Spastic paraparesis with generalized hyperreflexia and extensor plantar responses. Neur...Pendular Horizontal Oscillations; Left Beating Nystagmus; Obtrusive Saccades; Bilateral Gaze Evoked Nystagmus; Saccadic Dysmetria; Oscillopsia; Titubation; Ataxia; Multiple Sclerosis; Primary Position Horizontal Nystagmus; Gaze Evoked Horizontal Nystagmus; Horizontal Saccadic Dysmetria
20 LateropulsionShirley H. Wray, MD, PhD, FRCPThis 60 year old patient has Wallenberg's syndrome due to infarction of the left dorsolateral medulla. Wallenberg's syndrome is the best recognized syndrome involving the vestibular nuclei and adjacent structures. Unilateral infarcts affecting the vestibular nuclei may produce an oculomotor imbalanc...Deviation of the Eyes Under Closed Lids; Lateropulsion; Dorsolateral Medullary Infarction; Medulla Infarct
21 Alcoholic Cerebellar DegenerationShirley H. Wray, MD, PhD, FRCPThe patient is a 72 year old woman who presented with a 4 year history of progressive difficulty with balance, frequent falls and unsteadiness walking. She required a cane to steady herself. Past History: Significant for alcohol abuse. In 1980, she came to Boston for a second opinion and was seen in...Square Wave Jerks; Dysmetria; Horizontal Saccadic Hypermetria; Horizontal Gaze Evoked Nystagmus; Saccadic Pursuit; Gait Ataxia; Alcoholic Cerebellar Degeneration; Gaze Evoked Horizontal Nystagmus; Horizontal Saccadic Dysmetria; Alcohol
22 Saccades and Saccadic OscillationsShirley H. Wray, MD, PhD, FRCPA PowerPoint slideshow demonstrating normal eye movements.Normal Eye Movements
23 Convergence InsufficiencyShirley H. Wray, MD, PhD, FRCPA PowerPoint slideshow describing the condition.Basal Ganglia; Blepharoclonus; Convergence Insufficiency; Parkinson's Disease- Dopamine deficiency; Saccadic Breakdown of Smooth Pursuit; Slow Hypometric Horizontal Saccades; Slow Hypometric Saccades
24 Congenital Horizontal Gaze Palsy Progressive ScoliosisShirley H. Wray, MD, PhD, FRCPA PowerPoint slideshow describing the condition.Congenital Cranial Disinnervation Syndrome; Congenital Horizontal Gaze Palsy; Mutation of the ROBO 3 Gene on Chromosome 11q23-q25; Progressive Scoliosis
25 Paraneoplastic OpsocolonusShirley H. Wray, MD, PhD, FRCPA PowerPoint slideshow describing the condition.Adenocarcinoma of the Breast; Anti-Ri Antibody; Ocular Flutter; Opsoclonus; Oscillopsia; Paraneoplastic Cerebellar Syndrome; Paraneoplastic Ocular Flutter; Paraneoplastic Opsoclonus; Saccadic Oscillations
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