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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.
52 Periphlebitis in Optic Neuritis (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 35-year-old otherwise-healthy woman developed typical optic neuritis OD with excellent recovery. She had no clinical evidence of multiple sclerosis at that time. She presented in August of 1991, at which time perivenous sheathing was seen in the retinal periphery OU. A limited workup was negati...
53 Tadpole Pupil (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyIntermittent dilation of the pupils may occur as a benign phenomenon in healthy young adults. In the absence of other third nerve signs, (eg, ptosis, diplopia, ophthalmoplegia), an isolated transient dilation of the pupil in an otherwise healthy adult is unlikely to represent a third nerve palsy. Tr...
54 Chiasmal Herniation (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis woman was 61 years old when she underwent initial neuro-ophthalmologic evaluation. Twenty-three years earlier, she had undergone removal of a pituitary adenoma followed by radiation therapy. At that time, she had noted a preoperative visual field defect that improved somewhat after the surgery....
55 Moyamoya Disease (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 32-year-old woman was referred with a history of 4 days of loss of vision OD. She had a history of manic depressive illness and IV drug abuse; she had been HIV tested 4 weeks before and was negative. She said she last injected cocaine 5 days before being seen, the night before she awoke with th...
56 Paraneoplastic Disease (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 46-year-old woman noted progressive bilateral visual loss over a 10-month period. She had a malignant melanoma removed from her right thigh 2 years ago and excisional biopsy of an inguinal node metastasis 8 months ago. She also complained of poor night vision and rare intermittent ""sparkles"" ...
57 Radiation Retinopathies (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyRadiation retinopathy may mimic diabetic or hypertensive optic neuropathy. A history of irradiation to the eye, orbit, or head is mandatory. Radiation retinopathy usually occurs many months after radiation therapy.
58 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.
59 Multiple Myeloma (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 48-year-old female was seen in May 1996 with a history of 2 months of diplopia from a right abducens palsy. This was due to the recurrence of myeloma that had initially been diagnosed and treated with radiation and chemotherapy 9 years before and required further therapy, including bone marrow ...
60 Histiocytosis (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 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 image demonstrates the optic nerve infiltration. He was treated with ra...
61 Optic Neuropathy with Sinus Disease (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThe patient is a 66-year-old man with a history of ethanol abuse. He presented with 3 months of right-sided headache and a few days of progressive visual loss OD to hand motions only. When seen by the orbital service, he had nearly complete ophthalmoplegia and ptosis. Sinus biopsy showed fungus, whi...
62 Saturday Night Retinopathy (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 32-year-old woman was referred with a history of 4 days of loss of vision OD. She had a history of manic depressive illness and IV drug abuse; she had been HIV tested 4 weeks before and was negative. She said she last injected cocaine 5 days before being seen, the night before she awoke with th...
63 Temporal Arteritis (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 74-year-old asthmatic male had acute visual loss OS while watching the Super Bowl in 1994. He was seen the next day by a retina specialist, who noted that his optic disc was normal and referred the patient to a neuro-ophthalmologist, who evaluated him about 40 hours after his visual loss. He wa...
64 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...
65 CentralBranch Retinal Artery Occlusion (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyOcclusion of a branch or central retinal artery may result in acute visual loss. The ophthalmoscopic findings are retinal whitening due to ischemic retina in the distribution of the occluded artery. Sparing or selective involvement of cilioretinal artery branches may occur. Patients with a central r...
66 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.
67 Superior Ophthalmic Vein Thrombosis (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyThis 27-year-old woman had no past ocular history and presented with 3 weeks of redness OS that has been treated by the referring doctor as allergic conjunctivitis. She was referred for evaluation when she developed binocular diplopia. Her past medical history included phlebitis and one miscarriage ...
68 Lymphoma (PowerPoint)AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyIntraocular lymphoma may present with an unexplained vitritis, optic disc infiltration, or choroidal infiltration. One unusual manifestation or large-cell lymphoma is this leopard-spot appearance.
69 Acquired HyperopiaAAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology SocietyChoroidal 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...
70 Temporal Atrophy (PowerPoint)William F. Hoyt PhD, Professor Emeritus, University of California, San FranciscoSegmental Atrophy - Temporal pallor - Nutritional amblyopia (alcoholic). 1985.
71 Thyroid Associated Orbitopathy (TAO) (PPT)Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis 71 year old woman (Wray case 925-4) was referred with bilateral optic neuropathy and thyroid associated ophthalmopathy (TAO) of Graves' Disease. She had been treated for primary hyperthyroidism on three occasions with radioactive iodine and was taking Tapazole 5 mg daily. Neuro-ophthalmological...
72 Horizontal_Gaze_PalsyShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis 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...
73 Cavernous_Sinus_MeningiomaShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis 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...
74 Hemifacial SpasmShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe 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 twi...
75 Chest_CT_Thymoma_guest_lectureRobert A. Novelline, MD, Massachusetts General Hospital, Harvard Medical SchoolThe 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...
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