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26 Chiari I MalformationShirley H. Wray, MD, PhD, FRCPSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/295, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/323, and http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/61Downbeat Nystagmus; Oscillopsia; Chiari-1 Malformation; Primary Position Downbeat Nystagmus; Vertical Saccadic Dysmetria; Horizontal Saccadic Dysmetria; Ataxia; Dysmetria; Chiari Malformation
27 Paraneoplastic Upbeat NystagmusShirley H. Wray, MD, PhD, FRCPA PowerPoint slideshow describing the condition.Anti-Hu - Associated Paraneoplastic Encephalitis Ataxia; Horizontal Saccadic Dysmetria; Lid Nystagmus; Oscillopsia; Pancreatic Endocrine Carcinoma; Paraneoplastic Cerebellar Syndrome; Paraneoplastic Upbeat Nystagmus; Primary Position Upbeat Nystagmus; Saccadic Dysmetria; Saccadic Pursuit; Square Wa...
28 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
29 Eyebrow SpasmDaniel J. Costello, MDSlideshow describing condition.Bipolar Affective Disorder; Epileptic Seizures; Primary Position Left Beating Nystagmus; Rhythmic Eyebrow Spasm; Torsional Nystagmus; Tuberous Sclerosis Complex (TSC-2 DNA sequence variant)
30 Eyebrow Spasm (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThis case is published courtesy of Daniel J. Costello, M.D., Department of Neurology, Massachusetts General Hospital, Boston. The patient is a 32-year-old right-handed man with an established diagnosis of Tuberous Sclerosis Complex characterized by: -medically intractable epilepsy -developmental del...Rhythmic Eyebrow Spasm; Torsional Nystagmus; Primary Position Left Beating Nystagmus; Epileptic Seizures; Tuberous Sclerosis Complex (TSC-2 DNA sequence variant); Bipolar Affective Disorder
31 Paraneoplastic Anti-Hu and Anti-CV2 Positive Ataxic (Cerebellar and Sensory Ganglionopathy) EncephalitisAnuj Rastogi; Rahul Sharma; Gustavo Saposnik; Alexandra MuccilliWe describe a case of an elderly man with Non-small Cell Lung Cancer, presenting with paraneoplastic Anti-Hu and Anti-CV2 positive encephalitis. He had both cerebellar ataxia and sensory ataxia, likely from the paraneoplastic induced cerebellar degeneration and sensory ganglionopathy, respectively. ...Anti-CV2; Anti-Hu; Ataxia; Cerebellar Ataxia; Encephalitis; Nystagmus; Sensory Ganglionopathy
32 Alcoholic Cerebellar DegenerationShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Alcoholic Cerebellar Degeneration; Dysmetria; Gait Ataxia; Gaze Evoked Horizontal Nystagmus; Horizontal Gaze Evoked Nystagmus; Horizontal Saccadic Dysmetria; Horizontal Saccadic Hypermetria; Saccadic Pursuit; Square Wave Jerks
33 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
34 Pontine InfarctionShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Abducting Nystagmus; Convergence Normal; Fisher's One-and-a-Half Syndrome; Pontine Infarct; Unilateral Horizontal Gaze Palsy Infarct; Unilateral Horizontal Gaze Palsy; Unilateral Internuclear Ophthalmoplegia; Upbeat Nystagmus on Upgaze
35 Pontine_InfarctionShirley H. Wray, MD, PhD, FRCPThe patient is a 62 year old right handed man, status post myocardial infarction in 1989 and on Coumadin. In 1993 he presented with a history of three separate TIAs 1.Instantaneous perioral tingling and/or numbness lasting less than 1 minute. 2.Episodic numbness of the right hand and foot lasting le...Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Fisher's One-and-a-Half Syndrome; Pontine Infarct; Unilateral Horizontal Gaze Palsy Infarct; Abducting Nystagmus
36 Treatment Outcomes of Ocular Manifestations in Wernicke's Encephalopathy: Case ReportWhitney Stuard Sambhariya, PhD, Medical Student; Melanie Truong-Le, DO, ODThe case of a 28- year-old woman with a past medical history of gastric sleeve who was reported to have blurry vision and presented to neuro-ophthalmology with double vision. On examination the patient had bilateral abducens palsy, alternating upbeat and downbeat nystagmus with a torsional component...Wernicke's Encephalopathy; Ocular Manifestations; Neuro-ophthalmology; Abducens Palsy; Nystagmus; Double Vision; Blurry Vision
37 Treatment Outcomes of Ocular Manifestations in Wernicke's Encephalopathy: ImagesWhitney Stuard Sambhariya PhD; Melanie Truong-Le, DO, ODThe case of a 28- year-old woman with a past medical history of gastric sleeve who was reported to have blurry vision and presented to neuro-ophthalmology with double vision. On examination the patient had bilateral abducens palsy, alternating upbeat and downbeat nystagmus with a torsional component...Wernicke's Encephalopathy; Ocular manifestations; Neuro-ophthalmology; Sbducens palsy; Nystagmus; Double vision; Blurry vision
38 Saccades (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThe video of the normal eye movement examination was made with the assistance of Dr. Terrence Millette, a neurologist and former Fellow with me in 1985-1986. Introduction to the Saccadic System Saccades are fast eye movements that bring the image of an object of interest onto the fovea. They consist...Normal Eye Movements; Examination, Ocular; Saccades; Optokinetic Nystagmus Drum (OKN Drum); Pursuit; Ocular Motility
39 Serial Examination and Evolution of Horizontal Gaze Palsy in Thiamine DeficiencyMaxwell Nyce, OD; Joshua Chisholm, OD; Julia Szmada, OD; Jorge C Kattah, MDNeurology consult of patient with hearing loss following vertical band sleeve gastroplasty. See associated video: https://collections.lib.utah.edu/details?id=1512438Gaze Palsy; Gaze Paretic Nystagmus; Vestibular Loss; Hearing Loss; Loss of Speech Comprehension; Encephalopathy
40 Neuro-ophthalmologic Findings in Cerebellar StrokeZoe Rebecca Williams; Aishwarya GaneshThis PowerPoint reviews the anticipated neuro-ophthalmologic findings in cerebellar strokes including posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA) territory infarcts. The review includes discussion of potential ocular mi...AICA; Cerebellar Esotropia; Cerebellar Infarct; Lateral Medullary Syndrome; Nystagmus; Ocular Lateropulsion; PICA; SCA; Skew Deviation
41 One and a Half SyndromeShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Abducens Nuclear Lesion; Abducting Nystagmus; Cavernous Angioma; Convergence Absent; Convergence Normal; Esotropia; Facial Palsy; Facial Weakness; Fisher's One-and-a-Half Syndrome; Gaze Evoked Upbeat Nystagmus; Multiple Sclerosis; Pendular Vertical Oscillations; Pontine Hemorrhage; Pontine Infarct;...
42 Cavernous Sinus MeningiomaShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Abducting Nystagmus; Cavernous Angioma; Convergence Normal; Facial Palsy; Facial Weakness; Fisher's One-and-a-Half Syndrome; Pendular Vertical Oscillations; Pontine Hemorrhage; Unilateral Gaze Palsy Hemorrhage; Unilateral Horizontal Gaze Palsy; Unilateral Internuclear Ophthalmoplegia; Upbeat Nystag...
43 Cavernous AngiomaShirley H. Wray, MD, PhD, FRCPThe patient is a 19 year old sophomore who presented in 1983 with numbness of the left hand, involving initially just the fingers, and numbness and weakness of the right side of the face. He described the numbness in his hand as if it was "intensely asleep". The facial numbness involved the perioral...Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Pendular Vertical Oscillations; Facial Palsy; Fisher's One-and-a-Half Syndrome; Pontine Hemorrhage; Cavernous Angioma; Unilateral Gaze Palsy Hemorrhage; Abducting Nystagmus; Fac...
44 Horizontal Gaze PalsyShirley H. Wray, MD, PhD, FRCPThis 56 year old woman with known adenocarcinoma of the breast presented with the recent onset of horizontal diplopia and deviation of her left eye inwards. Her oncologist referred her for a neuro-ophthalmic evaluation. This 56 year old woman with known adenocarcinoma of the breast presented with th...Unilateral Horizontal Gaze Palsy; Esotropia; Fascicular Sixth Nerve Palsy; Horizontal Gaze Evoked Nystagmus; Normal Convergence; Horizontal Oculocephalic Reflexes Absent; Facial Palsy (Bell's Palsy); Abducens Nuclear Lesion; Pontine Metastasis; Adenocarcinoma of the Breast; Unilateral Sixth Nerve Pa...
45 Midbrain HemorrhageShirley H. Wray, MD, PhD, FRCPThe patient is a 49 year old woman who was in good health until January 17, 1991. When, at work one morning, she had an acute attack of light headedness and double vision and collapsed on the floor without loss of consciousness. She developed a severe retro-orbital headache. She was taken to the loc...Supranuclear Paralysis of Upgaze Hemorrhage; Convergence Retraction Nystagmus; Vertical Oculocephalic Reflex Normal; Normal Convergence; Skew Deviation; Light/Near Dissociation of the Pupils; Pretectal Syndrome; Midbrain Hemorrhage; Cavernous Angioma
46 Midbrain HemorrhageShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Cavernous Angioma; Convergence Retraction Nystagmus; Light/Near Dissociation of the Pupils; Midbrain Hemorrhage; Normal Convergence; Pretectal Syndrome; Skew Deviation; Supranuclear Paralysis of Upgaze Hemorrhage; Vertical Oculocephalic Reflex Normal
47 Cavernous AngiomaShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Cavernous Angioma; Convergence Normal; Facial Palsy; Fisher's One-and-a-Half Syndrome; Pendular Vertical Oscillations; Pontine Hemorrhage; Unilateral Gaze Palsy Hemorrhage; Unilateral Horizontal Gaze Palsy; Unilateral Internuclear Ophthalmoplegia; Upbeat Nystagmus on Upgaze
48 Thalamic InfarctShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Absent Convergence; Artery of Percheron; Bilateral Ptosis; Horizontal Gaze Evoked Nystagmus; Somnolence; Supranuclear Paralysis of Downgaze Infarct; Supranuclear Paralysis of Downgaze; Thalamic Infarct; Thalamus Infarct; Top of the Basilar Syndrome; Vertical Oculocephalic Reflex Normal
49 Whipple's DiseaseShirley H. Wray, MD, PhD, FRCPA PowerPoint presentation describing Whipple's Disease.Absent Convergence; Bilateral Lid Nystagmus; CNS Whipple's Disease; Pendular Vergence Oscillations; Somnolence; Supranuclear Paralysis of Up and Downgaze Infection-Whipple's Disease; Supranuclear Paralysis of Up and Downgaze; Tropheryma Whippelii - Infection; Vertical Gaze Palsy (c)
50 Whipples Disease (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThe patient is a 44 year old woman with a past history of ethanol abuse. She was transferred to the Massachusetts General Hospital (MGH) on 3/10/93 for evaluation of memory impairment, hypothalamic dysfunction and a one month history of diplopia and ataxia. In February 1992 (13 months PTA), she deve...Somnolence; Supranuclear Paralysis of Up and Downgaze; Vertical gaze palsy (c); Absent convergence; Pendular vergence oscillations; Bilateral lid nystagmus; Tropheryma Whippelii - Infection; CNS Whipple's Disease; Supranuclear Paralysis of Up and Downgaze Infection-Whipple's Disease
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