NOVEL - Shirley H. Wray Collection
 
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26 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
27 Pseudo-Internculear OphthalmoplegiaThis 32 year old man had the acute onset of double vision followed very quickly by a drooping of the left eyelid. Past History: Negative for any previous episode of double vision No history of strabismus as a child No fatigue, neck weakness, difficulty in chewing or swallowing Family History: Neg...Image/MovingImage
28 Familial Myasthenia GravisIn 1999 Dr. A. G. Engel published a monograph on Myasthenia Gravis and Myasthenic Disorders with a chapter devoted to Congenital Myasthenic Syndromes. Dr. Engel systematically defined and classified hereditary and congenital myasthenic syndromes, delineated on the basis of their electrophysiologi...Image/MovingImage
29 Bilateral Sixth Nerve PalsyThis patient has CNS B-cell lymphoma involving the dura mater. She presented with a chief complaint of "double vision and a squint is his right eye". On examination she was found to have bilateral sixth nerve palsy and paralytic esotropia. Comment: Lymphoma involving the dura is uncommon. Most p...Image/MovingImage
30 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
31 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
32 Spasm of the Near ReflexThis 17 year old boy presented with episodic eye pain. He consulted an ophthalmologist for evaluation of his symptoms and also complained of periodic difficulty focusing. On examination he had periodic spasms of abnormal eye movements, with impairment of full abduction. His ophthalmologist cons...Image/MovingImage
33 Downbeat Nystagmus - Periodic Alternating NystagmusThis patient carries a diagnosis of multiple sclerosis.Image/MovingImage
34 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
35 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
36 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
37 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
38 Downbeat NystagmusIn 1984, this young woman was involved in a motor vehicle accident when her car was hit from behind. She struck her head on the dash board but had no loss of consciousness. She was able to get out of the car unaided and was immediately aware of pain in her neck. She thought that she had susta...Image/MovingImage
39 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
40 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
41 Elliptical NystagmusThe patient carries a diagnosis of multiple sclerosis.Image/MovingImage
42 Fisher's One and a Half SyndromeThis 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 ...Image/MovingImage
43 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
44 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
45 Fisher's One and a Half SyndromeThis 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...Image/MovingImage
46 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
47 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
48 Opsoclonus in The DarkN/AImage/MovingImage
49 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
50 Convergence InsufficiencyThe patient is a 58 year old man with idiopathic Parkinson's Disease for five years. He presented with an increasing shuffling gait, marked bradykinesia, mild to moderate rigidity in all four limbs and impairment in rapid movements of the hands. When he attempted to standup and walk he needed to...Image/MovingImage
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