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51 Papilledema and Resolution (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 42-year-old male with pseudotumor cerebri and chronic papilledema demonstrated refractile bodies, which can be seen with chronic optic disc edema. This image shows the chronic papilledema at presentation, with associated refractile hyaline bodies at the disc periphery in both eyes.Pseudotumor Cerebri/Papilledema; Edema; Papilledema and Resolution
52 Bilateral PtosisShirley H. Wray, MD, PhD, FRCPA PowerPoint slideshow of diagnosed patients.Bilateral Ptosis; Facial Weakness; Full Eye Movements; MuSK Antibody Myasthenia Gravis; Tongue Atrophy; Myasthenia Gravis
53 Ocular Motor ApraxiaShirley H. Wray, MD, PhD, FRCPPresentation covering an overview of Ocular Motor Apraxia. See also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/255, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/253, and http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/252Congenital Ocular Motor Apraxia; Head Thrust; Ocular Motor Apraxia
54 Alexia Without AgraphiaShirley H. Wray, MD, PhD, FRCPThe patient is a 69 year old left handed man with a history of hypertension, insulin dependent diabetes mellitus and atrial fibrillation. Treated with coumadin, adjusted to keep the INR between 2 and 3. On the morning of admission he awoke at 4 a.m., sat momentarily on the side of the bed and then s...Pure Alexia; Color Anomia; Right Homonymous Hemianopia; Alexia Without Agraphia; Infarct of the Left Visual Cortex and Splenium of the Corpus Callosum; Disconnection Syndrome; Occipital Infarct
55 Constructional ApraxiaShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Apraxia of the Left Hand; Constructional Apraxia; Degenerative CNS Disease; Dressing Apraxia; Progressive Lobar Atrophy; Right Parietal Lobe
56 Charles Bonnet SyndromeShirley H. Wray, MD, PhD, FRCPThe patient is a 79 year old woman with a chief complaint of visual hallucinations. She carries a diagnosis of glaucoma and cataracts. The patient was in good health until two weeks prior to admission when she noted a black cloud in her visual field in the top central area. The cloud gradually chang...Occipital Lobe; Visual Hallucinations; Release Hallucinations; Charles Bonnet Syndrome
57 Myasthenia Gravis (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThe 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 intern...Unilateral Ptosis; Unilateral Lid Retraction; Myasthenic Lid Twitch; External Ophthalmoplegia; Ocular Myasthenia Gravis; Tensilon Test; Thymolipoma; Generalized Myasthenia Gravis; Unilateral Myasthenia Gravis; Myasthenic Ptosis; Lid Retraction; Lid Twitch
58 Bilateral PtosisShirley H. Wray, MD, PhD, FRCPThis case, previously reported in 2007, is published courtesy of John Newsom-Davis, M.D., FRCP, FRS, CBE. Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford. This patient was unusual in presenting in early childhood and the development of persistent facial muscle and tongue ...Bilateral Ptosis; Full Eye Movements; Facial Weakness; Tongue Atrophy; MuSK Antibody Myasthenia Gravis
59 Ocular Myasthenia Gravis (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/264, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/337, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/332, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/265, and http://content.lib.utah.edu/cd...Unilateral ptosis; Positive tensilon test; Ocular Myasthenia Gravis; Unilateral Myasthenia Gravis; Ptosis -- Myasthenic Pseudo-internuclear Ophthalmoplegia; Bilateral Weakness of Adduction; Tensilon Test; Bilateral Myasthenia Gravis; Internuclear Ophthalmoplegia; Familial Myasthenia Gravis;...
60 Horizontal Gaze PalsyShirley H. Wray, MD, PhD, FRCPThis 56 year old woman with known adenocarcinoma of the breast presented with the recent onset of horizontal diplopia and deviation of her left eye inwards. Her oncologist referred her for a neuro-ophthalmic evaluation. This 56 year old woman with known adenocarcinoma of the breast presented with th...Unilateral Horizontal Gaze Palsy; Esotropia; Fascicular Sixth Nerve Palsy; Horizontal Gaze Evoked Nystagmus; Normal Convergence; Horizontal Oculocephalic Reflexes Absent; Facial Palsy (Bell's Palsy); Abducens Nuclear Lesion; Pontine Metastasis; Adenocarcinoma of the Breast; Unilateral Sixth Nerve Pa...
61 Chiari I MalformationShirley H. Wray, MD, PhD, FRCPSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/295, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/323, and http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/61Downbeat Nystagmus; Oscillopsia; Chiari-1 Malformation; Primary Position Downbeat Nystagmus; Vertical Saccadic Dysmetria; Horizontal Saccadic Dysmetria; Ataxia; Dysmetria; Chiari Malformation
62 Carotid Cavernous Fistulas (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 76-year-old woman has a 7-month history of redness and pressure sensation in both eyes that is worse in the morning. She has noted intermittent horizontal diplopia during this time. Angiography demonstrated a right dural cavernous sinus fistula, which was successfully occluded with direct injec...Dural Arteriovenous Malformation; Carotid Cavernous Fistulas
63 Leber's Optic Neuropathy (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietySeveral Primary Mutations result in Leber's hereditary optic neuropathy, including mitochondrial deletions at positions 11778, 3460, and 14484. Although the 11778 is the most common mutation, the 11484 has the best prognosis for spontaneous recovery. This case exhibits the 3460 mutation.Leber's Optic Neuropathy
64 Mitochondrial MyopathyShirley H. Wray, MD, PhD, FRCPA PowerPoint slideshow describing the condition.Bilateral Progressive External Ophthalmoplegia (PEO); Bilateral Ptosis; Cerebellar Degeneration with Ataxia; Complete External Ophthalmoplegia; External Ophthalmoplegia Affecting Upgaze; Facial Weakness; Kearns-Sayre Syndrome; Mitochondrial Myopathy; Normal Pupils; PEO plus Atypical Retinitis Pigm...
65 Transient Monocular Blindness (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/293 and http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/96Retinal Emboli; Transient Monocular Blindness; Ocular Stroke; Transient; Transient Visual Loss; Sunlight Provoked Transient Monocular Blindness; Low Pressure Retinopathy; Ipsilateral Internal and External Carotid Occlusive Disease; Ischemic Eye Syndrome; Retinal Stroke; Ocular Ischemic Sy...
66 Congenital Horizontal Gaze Palsy, Progressive ScoliosisShirley H. Wray, MD, PhD, FRCPThe patient is an 8 year old boy with a rare autosomal recessive disorder characterized by congenital absence of conjugate horizontal eye movements preservation of vertical gaze and convergence and progressive scoliosis (HGPPS) developing in childhood. The child was referred to Dr. Cogan with a diag...Congenital Horizontal Gaze Palsy; Progressive Scoliosis; Mutation of the ROBO 3 Gene on Chromosome 11q23-q25; Congenital Cranial Disinnervation Syndrome; Mobius Syndrome
67 Convergence InsufficiencyShirley H. Wray, MD, PhD, FRCPThe patient is a 73 year old man with a ten year history of idiopathic Parkinson's disease characterized by difficulty in walking, generalized rigidity and a mild tremor of his hands at rest with deterioration in his handwriting. He denied any memory impairment or loss of cognitive function. He was ...Basal Ganglia; Blepharoclonus; Convergence Insufficiency; Slow Hypometric Saccades; Saccadic Breakdown of Smooth Pursuit; Parkinson's Disease- Dopamine deficiency; Slow Hypometric Horizontal Saccades; Convergence
68 Blepharospasm Round-Up (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThe patient is a 60 year old estate manager with a history of retinal laser therapy, dry eyes and age related bilateral ptosis. He carries a diagnosis of hilar lymphadenopathy due to sarcoid and has had cancer of the kidney. He presented in 1995 with a 6 month history of frequent blinking and spasms...Benign Essential Blepharospasm; Focal Dystonia; Blepharospasm
69 Eyebrow Spasm (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThis case is published courtesy of Daniel J. Costello, M.D., Department of Neurology, Massachusetts General Hospital, Boston. The patient is a 32-year-old right-handed man with an established diagnosis of Tuberous Sclerosis Complex characterized by: -medically intractable epilepsy -developmental del...Rhythmic Eyebrow Spasm; Torsional Nystagmus; Primary Position Left Beating Nystagmus; Epileptic Seizures; Tuberous Sclerosis Complex (TSC-2 DNA sequence variant); Bipolar Affective Disorder
70 Cavernous Sinus MeningiomaShirley H. Wray, MD, PhD, FRCPThis patient is a 46 year old woman from Portugal who was admitted to the Massachusetts General Hospital in September 1986 with ophthalmoplegia of the left eye (OS) and signs of aberrant reinnervation of the third nerve. She presented, in August 1985, with an episode of diplopia. The diplopia was su...Ptosis; Unilateral Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Paresis of Abduction; Sixth Nerve Palsy; Oculomotor Nerve; Cavernous Sinus Meningioma; Cavernous Sinus Syndrome; Unilateral Oculomotor Third Nerve Palsy; Unilateral Sixth Nerve Palsy
71 CNS LymphomaShirley H. Wray, MD, PhD, FRCPThe patient is a 70 year old Italian man with atrial fibrillation on long-term coumadin therapy. In October 1995, he developed generalized headache, horizontal double vision and his left eye deviated inwards (esotropia). A diagnosis of left sixth nerve palsy was made and attributed to microvascular ...Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS Non-Hodgkin's Lymphoma; Cavernous Sinus Syndrome; Lymphoma
72 AneurysmsAAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyAneurisms may result in neuro-ophthalmologic sign and symptoms by direct compression of the afferent or efferent systems or by the secondary effects of hemorrhage. Basilar aneurisms may result in ocular motor deficits such as a unilateral or bilateral third nerve palsy.Aneurysm
73 Bilateral Internuclear OphthalmoplegiaShirley H. Wray, MD, PhD, FRCPThis patient was seen at the Yale Eye Center at the age of 37. She had a long history of multiple sclerosis. At age 22, she had an acute attack of optic neuritis in the left eye which recovered fully within three weeks. Some months later she had a recurrent episode in the same eye, which also recove...Bilateral Internuclear Ophthalmoplegia; Pendular Horizontal Oscillations; Lid Nystagmus; Upbeat Nystagmus; Botulinum Toxin Therapy; Multiple Sclerosis; Horizontal Pendular Nystagmus; Gaze Evoked Upbeat Nystagmus; Abducting Nystagmus
74 Internuclear Ophthalmoplegia in Childhood (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThis case was reported by Cogan DG and Wray SH. Internuclear ophthalmoplegia as an early sign of brain tumor. Neurology 1970; 20:629-633. The patient is Case 1. He is a 4 ½ year old boy whose parents noted that the right eye had been "drifting" for four months. On examination the only significant f...Bilateral Internuclear Ophthalmoplegia; Upbeat Nystagmus; Medulloblastoma; Abducting Nystagmus
75 Supranuclear Paralysis of Vertical GazeShirley H. Wray, MD, PhD, FRCPThis 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 aro...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...
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