Videos, clinical notes and related presentations concerning neuro-ophthalmological and neurovisual disorders collected during Dr. Wray's work as the Director of Neuro-Visual Disorders at Massachusetts General Hospital.
Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General Hospital.
NOVEL: https://novel.utah.edu/
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| Identifier | Title | History | Subject | ||
|---|---|---|---|---|---|
| 51 |
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166-26 | Fascicular Third Nerve Palsy | The patient is a 76 year old woman who woke one morning unable to see out of her right eye because of ptosis. She came to the Massachusetts General Hospital emergency room and was admitted. Neurological Examination: Right third nerve palsy involving the pupil Ataxia of the left hand on finger-nose t... | Ptosis; Fascicular Third Nerve Palsy; Fixed Dilated Pupil; Contralateral Limb Ataxia; Claude Syndrome; Midbrain Infarct; Oculomotor Nerve; Unilateral Third Nerve Palsy; Subnuclear; Fascicular Oculomotor (Third) Nerve Palsy; Third Nerve Dysfunction |
| 52 |
 |
937-8 | Fisher's One and a Half Syndrome | This 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 num... | 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 |
| 53 |
 |
941-6 | Fisher's One and a Half Syndrome | The 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 lasti... | 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 |
| 54 |
 |
941-4 | Fisher's One and a Half Syndrome | The patient is a 56 year old woman who was seen by a Stroke Consult on the cardiac unit because she had difficulty opening her left eye and diplopia looking to the right. On examination she had ptosis OS and "a partial ophthalmoplegia" sparing the pupil. Diagnosis Partial left third nerve palsy.... | 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; Gaze Evoked Upbeat Nystagmus; Abducting Nystagmus |
| 55 |
 |
166-20 | Fisher's One and a Half Syndrome | This 28 year old woman had severe multiple sclerosis with a spastic paraparesis due to a lesion of the spinal cord. She was admitted to the Intensive Care Unit complaining of dizziness and double vision. Neuro-ophthalmologic examination: Visual acuity 20/30 OU Pupils, visual fields and fundi normal ... | Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Fisher's One-and-a-Half Syndrome; Multiple Sclerosis; Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy Demyelination; Gaze Evoked Upbeat Nystagmus; Abdu... |
| 56 |
 |
164-2 | Fisher's One and a Half Syndrome | This young patient presented with double vision and was found to have on examination the classical findings of Fisher's one-and-a-half syndrome which are: • Right internuclear ophthalmoplegia on gaze left with adduction weakness OD • Right horizontal gaze paresis with gaze evoked nystagmus • F... | Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Primary Position Upbeat Nystagmus; Convergence Normal; Fisher's One-and-a-Half Syndrome; Multiple Sclerosis; Unilateral Horizontal Gaze Palsy Demyelination; Gaze Evoked Upbeat Nystagmus; Abducting ... |
| 57 |
 |
166-14 | Fisher's One and a Half Syndrome | This young man was seen in the emergency room of his local hospital following the onset of severe headache, mild confusion and diplopia. Non-contrast CT brain scan showed: A right pontine hemorrhage He was transferred to the Massachusetts General Hospital ICU. Ocular Motility: Esotropia of the r... | Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Convergence Absent; Esotropia; Fisher's One-and-a-Half Syndrome; Facial Palsy; Abducens Nuclear Lesion; Pontine Hemorrhage; Unilateral Gaze Palsy Hemorrhage; Abducting Nystagmus; Facial Weakness |
| 58 |
 |
929-2 | Fourth Nerve Palsy | The patient is a 64 year old engineer who noted whilst driving around Thanksgiving time double vision with one image on top of the other. Vertical double vision persisted and he was referred to the Massachusetts General Hospital for evaluation. Past History: 1991 Hyperthyroidism with Graves' Dise... | Hypertropia; Superior Oblique Paresis; Inferior Oblique Overaction; Fourth Nerve Palsy; Trochlear Nerve; Bielchowsky Test; Head Tilt |
| 59 |
 |
940-1 | Fourth Nerve Palsy | The patient is a 32 year old, left handed chemistry teacher who presented with intermittent vertical double vision. In August 1992 she noted, particularly late in the evening when reading in bed, vertical double vision. The images were one on top of the other and on occasions one image was slig... | Hypertropia; Superior Oblique Paresis; Inferior Oblique Overaction; Fourth Nerve Palsy; Trochlear Nerve; Bielchowsky Test; Head Tilt; Fourth (Trochlear) |
| 60 |
 |
918-1 | Gaucher's Disease | This little boy has Gaucher's disease. Gaucher's disease is an autosomal recessive disorder, linked to chromosome 1q21, due to glucocerebroside β-glucosidase deficiency. There are three phenotypic variances of Gaucher's disease. Type I is the most common and lacks neurological features. Type 2 is... | "Disorder of Horizontal Saccades; Impaired Initiation; Slow Velocity; Arcuate Trajectory; Absent Optokinetic Nystagmus; Normal Vertical Gaze; Normal Pursuit; Juvenile Neuronopathic Gaucher's Disease, Type 3; Autosomal Recessive Linked to Chromosome 1q21; Glucocerebroside Deficiency; Horizontal Gaze ... |
| 61 |
 |
207-1 | Global Supranuclear Paralysis of Vertical Gaze | This case was presented to the Clinical Eye Movement Society at the American Neurological Association Meeting in October 2007. The patient is a healthy, 36 year old Lieutenant Commander in the Coast Guard who was last seen perfectly well at 2 a.m. on the day of admission. He awoke in the morning ... | Somnolence; Global Supranuclear Paralysis of Vertical Gaze; Absent Vertical Saccades and Pursuit Movements; Intact Convergence; Convergence Retraction Nystagmus; Ocular Dysmetria; Ocular Tilt Reaction; Lateropulsion; Unilateral Midbrain and Thalamic Infarct; Supranuclear Paralysis of Up and Downgaze... |
| 62 |
 |
937-1 | Hemifacial Spasm | The 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 t... | Lid Twitch; Hemifacial Spasm; Neurovascular Compression Syndrome of the Facial Nerve |
| 63 |
 |
161-19 | Hemifacial Spasm: Eyelid Twitching | This patient is an atypical case of hemifacial spasm because he is a young college student only 29 years of age. Hemifacial spasm usually develops in the fifth and sixth decade of life and affects women more than men. It often begins insidiously in the orbicularis oculi muscle in the early stage... | Lid Twitch; Hemifacial Spasm; Neurovascular Compression Syndrome of the Facial Nerve |
| 64 |
 |
948-1 | Information Processing in the Visual System: David H. Hubel, Nobel Laureate Physiology or Medicine 1981 | David H. Hubel is the John Enders University Professor of Neurobiology at Harvard Medical School. Born in Canada of American parents, he grew up in Montreal, graduated from McGill Medical School, and received training in neurology at the Montreal Neurological Institute and Johns Hopkins Hospital. ... | Architecture of the Visual Cortex; Information Processing in the Visual System; David H. Hubel; AVP Association Areas |
| 65 |
 |
161-1 | Jaw Winking | This young boy was born at full term after a normal pregnancy with congenital unilateral ptosis of the left eyelid. His mother noticed that when he was sucking on a bottle the ptotic eyelid opened and closed. A diagnosis of the Marcus-Gunn jaw winking phenomenon was made. The first case of thi... | Congenital Unilateral Ptosis; Jaw Winking; Lid Winking; Trigemino-oculomotor Synkinesis; Marcus-Gunn Jaw Winking Phenomenon; Congenital Ptosis; Marcus Gunn Jaw Wink |
| 66 |
 |
169-29 | Jaw Winking | This little boy was born with congenital ptosis of the left eyelid, which "flicked up and down" when his jaw moved. The pediatrician made a diagnosis of the Marcus-Gunn jaw winking phenomenon was made. The first case of this unusual synkinesis between the pterygoid muscles and the levator musc... | Congenital Unilateral Ptosis; Jaw Winking; Lid Winking; Trigemino-oculomotor Synkinesis; Marcus-Gunn Jaw Winking Phenomenon; Congenital Ptosis |
| 67 |
 |
169-28 | Latent Nystagmus | This is one of the first cases of latent nystagmus that I saw with Dr. Cogan in the 1970's. The presence of latent nystagmus was unknown to this patient, a little girl who was found to have latent nystagmus by the ophthalmologist at school trying to test the vision of each eye separately. When she... | Latent Nystagmus; Fusional Maldevelopment Nystagmus Syndrome |
| 68 |
 |
209-1 | Lateropulsion | This 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 |
| 69 |
 |
161-21 | Lateropulsion | This 44 year old woman has a diagnosis of Multiple Sclerosis. | |
| 70 |
 |
004-3 | Lid Lag | The classical eye signs of thyroid associated ophthalmopathy (TAO) of Graves' Disease is illustrated by case ID925-4. This 50 year old woman with TAO is included in the collection because she illustrates very well lid lag (persistent elevation of the upper eyelid in downgaze) - von Graefe sign E... | Lid Lag; Bilateral Exophthalmos; Restrictive Orbitopathy of Graves' Disease |
| 71 |
 |
041-1 | Migraine / PET Study | In December 1994 the New England Journal of Medicine published a remarkable paper Bilateral Spreading Cerebral Hypoperfusion during Spontaneous Migraine Headache. Roger P. Woods, Marco Iacoboni and John C. Mazziotta. which is reproduced in part, and accompanied by a video illustration. Courtesy of J... | Migraine Headache; Regional Cerebral Blood Flow; Migraine Visual Aura |
| 72 |
 |
939-4 | Migraine Visual Aura | The patient is a 73 year old retired teacher who was referred in 1993 for a second opinion regarding treatment of episodic visual hallucinations. As a school boy in junior school, he began to experience transient episodes of a spot appearing in the right lower homonymous quadrant of his field of vi... | Migraine Visual Aura; Occipital Lobe; Visual Phenomena |
| 73 |
|
932-5 | Migraine Visual Aura | The patient is a 9 year old right handed boy who developed headaches in 1993 at the age of 8. At that time he told his mother that he had bad headaches starting at the back of the head, usually bioccipital, spreading over the top of the head to his forehead. The headaches were short in duration la... | Migraine Visual Aura without headache; Metamorphopsia; Macropsia - Hemi-macropsia; Alice in Wonderland Syndrome; Occipital Lobe; Visual Phenomena |
| 74 |
 |
947-2 | Migraine Visual Aura: A Discussion with Nobel Laureate David H. Hubel | I am greatly indebted to the Nobel Laureate, David Hubel for his permission to publish his description of his migraine aura. The recording was made fortuitously at the time that I invited David to the Unit for Neuro-Visual Disorders to record an audio clip describing the experiments in the cat that... | Migraine Visual Aura; Occipital Lobe; Visual Phenomena; David H. Hubel |
| 75 |
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947-1 | Migraine Visual Aura: A Personal Account | I am greatly indebted to the Nobel Laureate, David Hubel for his permission to publish his description of his migraine aura. The recording was made fortuitously at the time that I invited David to the Unit for Neuro-Visual Disorders to record an audio clip describing the experiments in the cat that... | Migraine Visual Aura; Occipital Lobe; Visual Phenomena; David H. Hubel |