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26 Neonatal OpsoclonusThis child was one of the first cases of opsoclonus that I saw with Dr. Cogan in the early 1970's. The baby is a unique case in that in addition to neonatal opsoclonus with the characteristic multidirectional conjugate back-to-back saccades, periods of large amplitude upbeat nystagmus also occurred....Image/MovingImage
27 Neonatal OpsoclonusThis child was one of the first cases of opsoclonus that I saw with Dr. Cogan in the early 1970's. He carried a diagnosis of strabismus with deviation of the left eye. In this child, opsoclonus occurred as a transient phenomenon in an otherwise healthy infant. For a complete overview of opsoclonus i...Image/MovingImage
28 Nuclear Third Nerve PalsyThe following case is the first patient I saw with a nuclear third nerve palsy. The patient is a 52 year old man with hypertension and hyperlipidemia. He awoke one morning unable to open his eyes. To walk he tilted his head backwards and looked down. He came to the emergency room of the Massach...Image/MovingImage
29 Ocular DippingThe patient is a 32 year old woman with juvenile diabetes mellitus. She collapsed at home and was rushed to the emergency room where a diagnosis of a locked-in syndrome was made. The term Locked-in Syndrome (LiS) was coined in 1966 by Plum and Posner for a condition with the following criteria: 1....Image/MovingImage
30 Ocular FlutterThis patient was seen in the Neurovisual Clinic for evaluation of a monocular attack of optic neuritis which completely resolved. Six months later, she became unsteady walking and was found to have bilateral ataxia. She was given a diagnosis of multiple sclerosis (MS). Neuro-ophthalmological examin...Image/MovingImage
31 Ocular FlutterThis little boy complained of difficulty focusing. On examination he was found to have ocular flutter. He was otherwise neurologically intact and in good general health. Investigations were directed to rule out 1. Neuroblastoma (see ID 936-8) 2. Enterovirus infection 3. Parainfect...Image/MovingImage
32 Ocular Motor ApraxiaThis elderly patient was referred to the Movement Disorder Clinic for evaluation of abnormal head thrust movements when asked to look on command to the right or to the left. His random eye movements were full vertically and horizontally. Diagnosis: Acquired Ocular Motor Apraxia ...Image/MovingImage
33 Palatal TremorThis patient presented with an acute brainstem stroke with: 1. A unilateral lower motor neuron (LMN) facial palsy on the right 2. A horizontal gaze palsy to the right 3. Mild unsteadiness walking The infarct localized clinically to the right side of the pons involving the abducens nucleus and the g...Image/MovingImage
34 PalinopsiaThe patient is a healthy 59 year old woman who presented in 1978 with transiet visual symptoms. The first visual disturbance occurred in December 1978 when suddenly she noted: • Fluttering of vision in the left eye (OS) • The appearance of a central black spot • Around the edge of the blac...Image/MovingImage
35 Parainfectious OpsoclonusThis child was one of a group of children with opsoclonus that I saw with Dr. Cogan in the early 1970's. This boy carries the diagnosis of parainfectious brainstem encephalitis. In the absence of myoclonus, myoclonic encephalopathy often referred to as dancing eyes and dancing feet was ruled out. ...Image/MovingImage
36 Paraneoplastic Opsoclonus/FlutterIn 1975 this patient presented with oscillopsia due to opsoclonus with ocular flutter. Opsoclonus with flutter is a paraneoplastic syndrome associated with occult cancer of the breast, ovary and lung. This patient had cancer of the breast. In 1954 Cogan first used the term "ocular flutter" to d...Image/MovingImage
37 Paroxysmal Skew DeviationIn 1970 I saw this unique case with Dr. Cogan. The patient is a 60 year old hypertensive woman with a ten year history of intermittent vertical double vision and oscillopsia. Neurological examination between attacks of diplopia showed: Visual acuity 20/25 OU Visual fields, pupils and fundus exami...Image/MovingImage
38 Pendular Vertical OscillationsThis 60 year old patient presented in 1979 for evaluation of blurred vision watching television and a sense of unsteadiness when walking down stairs. Past History: Hypertension for years A "small stroke" 3 months prior to this evaluation, presenting acutely with dizziness and vertical double vision....Image/MovingImage
39 Pseudo-Internuclear OphthalmoplegiaIn 1969 this 54 year old man presented with a one month history of blurry vision which started suddenly one afternoon. He said he was "just not focusing" and he saw two images when he "relaxed his sight". He could see clearly covering one eye. Initially, the difficulty in focusing occurred la...Image/MovingImage
40 See-saw NystagmusThe patient is a 21 year old woman who was referred to an endocrinologist for evaluation of amenorrhea. She was found to have bitemporal hemianopia and compression of the chiasm. CT Brain showed: A partially cystic, partially solid suprasellar mass with focal calcification consistent with a crani...Image/MovingImage
41 Supranuclear Paralysis of DowngazeJohn Trojanowski and I published this case in Neurology in 1980.(12) At that time, it was one of the first of five reports in the literature of the pathological localization of lesions in the midbrain that are responsible for selective supranuclear paralysis of downgaze. This case is of particula...Image/MovingImage
42 Supranuclear Paralysis of Up and DowngazeThis patient presented to the Dementia Clinic for evaluation of forgetfulness, impaired recall memory, lack of attentiveness and spontaneity and progressive impairment of mobility over a period of one year. Neurological examination: The patient was found to have multisystem involvement with: 1. Mi...Image/MovingImage
43 Supranuclear Paralysis of UpgazeThis young child presented with headache and unsteadiness. He was found to have obstructive hydrocephalus, aqueduct stenosis and a medulloblastoma. The constellation of clinical eye signs localized to the Dorsal Midbrain and included: • Supranuclear paralysis of upgaze (saccadic and pursuit move...Image/MovingImage
44 Supranuclear Vertical Gaze PalsyThe patient is a 60 year old woman who was given a diagnosis of Progressive supranuclear palsy six months before she was referred by the Movement Disorders Clinic for evaluation of difficulty reading. Family History: Negative for neurodegenerative disease. Neuro-ophthalmological examination: Sup...Image/MovingImage
45 Unilateral Horizontal Gaze PalsyThe patient is a 62 year old woman with known hypertension. She was referred by her PCP because she could not move her eyes fully and look left. Neuro-ophthalmological examination: Visual acuity, fields, pupils and fundi normal Ocular Motility: • Slight head turn to the left • Conjugate dev...Image/MovingImage
46 Unilateral PtosisThe 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 in...Image/MovingImage
47 Upbeat NystagmusThe patient, a 36 year old Italian, presented in October 1967, at the age of 27, with acute dizziness and ataxia. He was evaluated in Rome. A pneumoencephalogram showed hydrocephalus, attributed to arachnoiditis, and a ventriculo-atrial shunt was placed. Three months post shunt placement he ...Image/MovingImage
48 Visual NeglectThe patient following infarction of the non-dominant right parietal lobe has visual hemi-neglect on the left. Review: (ref 2) Patient's with hemi-neglect ignore or fail to attend to stimuli on the side of space contralateral to their lesion. Neglect can be multimodal in that all stimuli whether audi...Image/MovingImage
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