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276 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 1-year-old child with familial erythrophagocytic lymphohistiocytosis was readmitted with a fever and was noted to have bilateral blindness. The spinal tap showed a protein of 148, with 178 WBC with 98% ""lymphocytes."" This MRI image demonstrates the optic nerve infiltration. He was treated wit...
277 Optic Disc Drusen Visual FieldsThomas R. Wolf, MDThis is the visual field of patient with optic nerve drusen. Whereas they typically do not cause central field loss, optic disc drusen may cause nerve fiber bundle layer defects and, thus, peripheral field defects, including altitudinal defects (seen inferiorly in the left eye) or arcuate defects (s...
278 Isolated Optic Neuritis/NeuropathyRichard H. Legge, MDPapilledema is a term reserved for optic disc edema related to increased intracranial pressure (eg. Papilledema, sixth nerve palsy, headache), a normal neuroimaging study, and an elevated opening pressure with normal cerebrospinal fluid contents.
279 Chiasmal SyndromesLarry P. Frohman, MDThis 36-year-old woman presented in 1988 with 3 weeks of vertical binocular diplopia. She was a known amblyope OD. Her examination was notable for a right hyperdeviation of 1 PD present in right gaze and a subtle left noncongruous homonymous field defect. She was lost to follow-up, but 5 years later...
280 Ocular Manifestations of Congenital/Inherited DiseasesLarry P. Frohman, MDThis 14-year-old boy presented with sudden visual loss of the right eye that occurred 3 weeks before and due to a central retinal vein occlusion. His ocular history was quite complicated. He had had a resection of a lymphangioma of the left upper lid at age 7 months and underwent left orbitotomy for...
281 Ocular Manifestations of Congenital/Inherited DiseasesLarry P. Frohman, MDThis 14-year-old boy presented with sudden visual loss of the right eye that occurred 3 weeks before and due to a central retinal vein occlusion. His ocular history was quite complicated. He had had a resection of a lymphangioma of the left upper lid at age 7 months and underwent left orbitotomy for...
282 Ocular Manifestations of Congenital/Inherited DiseasesMark J. Kupersmith, MDThis 9-year-old girl, who had complained of recurrent spontaneous bleeding from the palate and slight swelling and increased warmth over the left cheek, was found to have Wyburn-Mason syndrome. Image 1993_16 shows a small area of arteriovenous shunt on the left optic disc in this patient, who has no...
283 Ocular Manifestations of Congenital/Inherited DiseasesDaniel M. Jacobson MDThis 38-year-old man had unexplained poor vision in his left eye all his life and was told that he had some type of congenital vascular anomaly. He had no neurocutaneous problems. The photographs demonstrate a complex arteriovenous malformation with dilated loops of veins extending out from the nerv...
284 Neuro-Ophthalmic Imaging-CT ScanMitchell J. Wolin, MDIdiopathic orbital pseudotumor is an inflammatory disorder that may effect any part of the ocular anatomy. The site of inflammation determines the nomenclature. For example, involvement of the sclera is referred to as scleritis. And involvement of one or more of the extraocular muscles is referred t...
285 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 1-year-old child with familial erythrophagocytic lymphohistiocytosis was readmitted with a fever and was noted to have bilateral blindness. The spinal tap showed a protein of 148, with 178 WBC with 98% ""lymphocytes."" This MRI image demonstrates the optic nerve infiltration. He was treated wit...
286 Orbital TumorsLarry P. Frohman, MDThis 30-year-old man had a retrobulbar intraconal mass OS. The CT scans showed a heterogeneous lobulated enhancing mass, 2.2 x 1.9 x 1.8 cm. The case beautifully exhibits chorodial folds. The ultrasound showed internal reflectivity. The patient refused surgery. Pair with Images 97_60, 97_61, 97_62, ...
287 Orbital TumorsLarry P. Frohman, MDThis 30-year-old man had a retrobulbar intraconal mass OS. The CT scans showed a heterogeneous lobulated enhancing mass, 2.2 x 1.9 x 1.8 cm. The case beautifully exhibits chorodial folds. The ultrasound showed internal reflectivity. The patient refused surgery. Pair with Images 97_60, 97_61, 97_62, ...
288 Isolated Congenital Optic Disc AnomaliesLarry P. Frohman, MDThis 63-year-old man with amblyopia OD was seen for a question of ischemic optic neuropathy with a pale, swollen disc OD. The correct diagnosis is an exophytic capillary angioma of the optic nerve head. Disease/Diagnosis: Capillary Angioma.
289 Acquired Disc ChangesRosa A. Tang, MDOptociliary shunt vessels are venous collaterals that form after chronic venous obstruction. The presence of optic atrophy, progressive visual loss, and optociliary shunt vessels may indicate a compressive optic nerve lesion such as meningioma.
290 Isolated Optic Neuritis/NeuropathyAnthony C. Arnold, MDThis 42-year-old male with pseudotumor cerebri and chronic papilledema demonstrated refractile bodies, which can been seen with chronic optic disc edema. This image exhibits decreased disc edema and resolution of the refractile bodies OD after therapy. Pair with 96_01, 96_02, 96_04, 96_05, and 96_06...
291 Neuro-Ophthalmic Imaging-CT ScanLarry P. Frohman, MDThis patient was assaulted with a blunt object and suffered acute blindness due to traumatic optic neuropathy. Note how the lateral orbital wall has been fractured and displaced posteromedially into the region of the anterior optic canal.
292 Optic Tract Syndrome Due to Carotid Artery DolichoectasiaLarry P. Frohman, MDThis 43-year-old man was referred for evaluation of 6 months of visual loss OU. In retrospect, he had noticed increasing difficulty with his tennis game dating back over 3 years, as balls would pass him unexpectedly when hit to his backhand (left) side. The patient did not think this was progressive...
293 Optic Tract Syndrome Due to Carotid Artery DolichoectasiaLarry P. Frohman, MDThis 43-year-old man was referred for evaluation of 6 months of visual loss OU. In retrospect, he had noticed increasing difficulty with his tennis game dating back over 3 years, as balls would pass him unexpectedly when hit to his backhand (left) side. The patient did not think this was progressive...
294 Optic Tract Syndrome Due to Carotid Artery DolichoectasiaLarry P. Frohman, MDThis 43-year-old man was referred for evaluation of 6 months of visual loss OU. In retrospect, he had noticed increasing difficulty with his tennis game dating back over 3 years, as balls would pass him unexpectedly when hit to his backhand (left) side. The patient did not think this was progressive...
295 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 8-year-old girl had a history of acute lymphoblastic leukemia with neurologic involvement, with remission induced with radiation and chemotherapy. Her relapse showed as an isolated optic neuropathy with this fundus appearance. The other eye was normal. The MRI and spinal tap at this point were ...
296 Ocular Manifestations of Systemic DisordersRobert F. Saul, MDWilson's disease (hepatolenticular degeneration) is a progressive autosomal recessive multisystem disease that may result in cirrhosis of the liver, renal dysfunction, and motor neurologic disease. A Kayser-Fleischer ring may occur as a green-brown band at the level of Descemet's membrane in the cor...
297 Neuro-Ophthalmic Case With Notable Field ChangesMarilyn C. Kay, MDThis 28-year-old woman presented with a 4-week history of bilateral visual loss. She had a known history of multiple sclerosis. Her vision was 20/60 OD and 20/40 OS, with an RAPD OS and optic pallor OU. Her fields and MRI are shown. Optic tract lesions usually result in an incongruous homonymous hem...
298 Ocular Disease With Retinal FindingsWilliam Fletcher Hoyt, MDChoroidal folds may result from choroidal tumors, compression on the eye wall from thyroid ophthalmopathy, orbital pseudotumor, orbital tumor, posterior scleritis, hypotony, scleral laceration, retinal detachment, marked hyperopia, or secondary to papilledema. Intraocular pressure measurements, refr...
299 Isolated Congenital Optic Disc AnomaliesWilliam Fletcher Hoyt, MDThis patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline. Disease/Diagnosis: Tilted Discs.
300 Isolated Congenital Optic Disc AnomaliesAnthony C. Arnold, MDThis image shows drusen that are especially prominent superotemporally. Pair with 92_64 and 92_67.
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