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TitleHistoryType
26 Hemifacial Spasm: Eyelid TwitchingThis 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...Image/MovingImage
27 Jaw WinkingThis 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...Image/MovingImage
28 Congenital Ocular Motor ApraxiaThis baby was born at term after an uneventful pregnancy and normal delivery. He was the first and only child. There was no family history of any This baby was born at term after an uneventful pregnancy and normal delivery. He was the first and only child. There was no family history of any neurol...Image/MovingImage
29 Bilateral Internuclear Ophthalmoplegia (INO)The patient is a 48 year old woman who presented with horizontal double vision looking to the right and to the left. She also noted blurring of vision with the image jerking horizontally back and forth. Neuro-ophthalmological examination: Visual acuity 20/20 OU corrected Visual fields, pupils, and f...Image/MovingImage
30 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
31 Congenital Nystagmus: Oscillations of the EyesThis child has had nystagmus since childhood with a head turn to the left. He was seen by his pediatrician. Diagnosis: Horizontal jerk nystagmus (congenital motor nystagmus) Congenital nystagmus Classification: The Classification of Eye Movement Abnormalities and Strabismus Working Group has recomme...Image/MovingImage
32 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
33 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
34 Fascicular Third Nerve PalsyThe 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...Image/MovingImage
35 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
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 Downbeat NystagmusThe patient is a 72 year old man who was found down and admitted as an emergency in coma. Neurological examination: Patient in coma failed to respond to painful stimuli. Downbeat nystagmus Lid nystagmus Pupils 2 mm OU responsive to light Corneal reflexes absent Oculocephalic reflex absent No resp...Image/MovingImage
38 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
39 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
40 Downbeat NystagmusThis patient carries a diagnosis of Type I Chiari malformation. Neurological symptoms of a Chiari malformation may not develop until adolescence or adult life as in this man. The symptoms may be those of: 1. Increased intracranial pressure, mainly headache 2. Progressive cerebellar ataxia 3. Progre...Image/MovingImage
41 Latent NystagmusThis 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...Image/MovingImage
42 Apraxia Eyelid OpeningThis patient first presented to his PCP with increasing immobility. A diagnosis of Parkinson's disease was made. When his condition progressed, he was referred to the Neurology Clinic. Neuro-ophthalmological examination showed: Apraxia of eyelid opening Impaired initiation of horizontal saccades ...Image/MovingImage
43 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
44 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
45 Bilateral Internuclear OphthalmoplegiaThe 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. Fa...Image/MovingImage
46 Congenital Nystagmus - Latent NystagmusThis boy was not recognized to have nystagmus until he accidentally discovered that he had blurred vision in one eye while pulling a sweater off over his head and blocking the vision of one eye. An ophthalmologist saw him and diagnosed latent nystagmus. He had no strabismus or any other ophthalmol...Image/MovingImage
47 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
48 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
49 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
50 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
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