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51 166-4Neonatal 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...Neonatal Opsoclonus; Lid Nystagmus; Saccadic Oscillations
52 166-6Parainfectious 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. ...Parainfectious Opsoclonus; Saccadic Oscillations
53 167-10Unilateral 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...Unilateral Horizontal Gaze Palsy; Conjugate Deviation of the Eyes; Normal Convergence; Oculocephalic Reflex Normal; Pontine Infarct; Unilateral Horizontal Gaze Palsy Infarct
54 167-11Supranuclear Paralysis of UpgazeThe patient is a 32 year old man who was admitted as an emergency with severe headache and papilledema. On examination he had signs of the Pretectal Syndrome. • Bilateral lid retraction in primary gaze - Collier's sign • Supranuclear paralysis of upgaze (saccades and pursuit) • Full horizon...Supranuclear Paralysis of Upgaze; Bilateral Lid Retraction - Collier's Sign; Convergence Retraction Nystagmus; Vertical Oculocephalic Reflex Normal; Normal Convergence; Light/Near Dissociation of the Pupils; Pretectal Syndrome; Dysgerminoma - Pineal Region Tumor; Lid Retraction; Upgaze Palsy; Dorsa...
55 167-6Pendular 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....Pendular Vertical Oscillations; Palatal Tremor (Myoclonus); Unilateral Horizontal Gaze to the Right; Skew Deviation; Ocular Tilt Reaction; Brainstem Infarct; Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillain - Mollaret Triangle
56 167-8Third Nerve Palsy; Aberrant ReinnervationThe patient is a 48 year old man from Saudi Arabia who came to the Massachusetts General Hospital for a second opinion and hopefully for surgical correction of ptosis of the left eye (OS). He had a long standing left third nerve palsy due to compression of the nerve trunk by a cavernous sinus mening...Ptosis; Unilateral Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Pupil Dilated and Fixed; Oculomotor Nerve; Cavernous Sinus Meningioma; Cavernous Sinus Syndrome; Aberrant Reinnervation
57 168-3Apraxia 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 ...Apraxia of Eyelid Opening; Impaired Initiation of Horizontal Saccades; Slow Hypometric Horizontal Saccades; Supranuclear Paralysis of Up and Downgaze Degeneration; Progressive Supranuclear Palsy - Tauopathy; Steele Richardson Olszewski Syndrome; CNS - Degeneration
58 168-6Downbeat Nystagmus - Periodic Alternating NystagmusThis patient carries a diagnosis of multiple sclerosis.Downbeat Nystagmus; Periodic Alternating Nystagmus; Multiple Sclerosis; Primary Position Downbeat Nystagmus
59 169-23Congenital Nystagmus: Oscillations of the Eyes-2This child was noted to have oscillations of the eyes in infancy and was given a diagnosis of congenital nystagmus.Congenital Nystagmus; Horizontal Pendular Nystagmus; Infantile Nystagmus Syndrome; Optokinetic Nystagmus Absent; Fusional Maldevelopment Nystagmus Syndrome; Horizontal Jerk Nystagmus; Congenital vs Acquired Nystagmus; Congenital Motor Nystagmus
60 169-25Visual 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...Impaired Initiation of Horizontal Saccades to the Left; Deviation of the Eyes to the Left Under Closed Eyelids; Normal Pursuit Eye Movements; Parietal Lobe Infarct; Visual Neglect
61 169-28Latent 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...Latent Nystagmus; Fusional Maldevelopment Nystagmus Syndrome
62 169-29Jaw 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...Congenital Unilateral Ptosis; Jaw Winking; Lid Winking; Trigemino-oculomotor Synkinesis; Marcus-Gunn Jaw Winking Phenomenon; Congenital Ptosis
63 169-34Bilateral 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...Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS B-Cell Lymphoma
64 169-37Paroxysmal Skew DeviationIn 1970 I saw this unique case with Dr. Cogan. The patient is a 60 year old hypertensive woman with a ten year history of intermittent vertical double vision and oscillopsia. Neurological examination between attacks of diplopia showed: Visual acuity 20/25 OU Visual fields, pupils and fundus exami...Paroxysmal Skew Deviation; Ocular Tilt Reaction; Otolith-Ocular Pathway; Skew Deviation
65 169-39Spasm 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...Spasm of the Near Reflex; Functional Convergence Spasm; Voluntary Blinking; Voluntary Nystagmus; Spasm of the Near Triad; Convergence Spasm
66 170-53Downbeat 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...Downbeat Nystagmus; Oscillopsia; Chiari-1 Malformation; Primary Position Downbeat Nystagmus
67 207-1Global Supranuclear Paralysis of Vertical GazeThis 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 ...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...
68 207-2Selective Saccadic PalsyThis case is published courtesy of Scott D.Z. Eggers, M.D., Department of Neurology, Mayo Clinic College of Medicine (1). The patient is a healthy 50 year old woman who underwent otherwise uncomplicated aortic valve replacement for an incidentally discovered ascending aortic aneurysm. Upon awakeni...Selective saccadic palsy after cardiac surgery; Supranuclear gaze palsy; Ocular motility; Bilateral Horizontal Gaze Palsy Hypoxia; Pontine Hypoxia; Cerebral Hypoxia
69 208-1Upbeat NystagmusThe patient is a 31 year old woman with a past history of morbid obesity treated in 2005 by gastric bypass with a weight change from 270 pounds to 170 pounds. In January 2008, she was admitted as an emergency to an outside hospital complaining of pressure headache with photophobia and phonophobia, n...Upbeat Nystagmus; Bilateral Lid Nystagmus; Wernicke's Disease; Morbid Obesity - Gastric Bypass Surgery; Primary Position Upbeat Nystagmus; Wernicke Encephalopathy; Thiamine Deficiency
70 209-1LateropulsionThis 60 year old patient has Wallenberg's syndrome due to infarction of the left dorsolateral medulla. Wallenberg's syndrome is the best recognized syndrome involving the vestibular nuclei and adjacent structures. Unilateral infarcts affecting the vestibular nuclei may produce an oculomotor imbalanc...Deviation of the Eyes Under Closed Lids; Lateropulsion; Dorsolateral Medullary Infarction; Medulla Infarct
71 210-1Bilateral PtosisThis 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
72 211-1Eyebrow SpasmThis 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...Rhythmic Eyebrow Spasm; Torsional Nystagmus; Primary Position Left Beating Nystagmus; Epileptic Seizures; Tuberous Sclerosis Complex (TSC-2 DNA sequence variant); Bipolar Affective Disorder
73 212-3Paraneoplastic Upbeat NystagmusThis case was presented to the Clinical Eye Movement Society at the American Neurological Association Meeting in October 2009. The patient is a 65 year old woman who was in good health until seven weeks prior to admission. On June 22/09 on the return flight from her daughter's wedding in Oregon she ...Upbeat Nystagmus; Lid Nystagmus; Square Wave Jerks (Saccadic Oscillations); Saccadic Dysmetria; Saccadic Pursuit; Paraneoplastic Syndrome; Paraneoplastic Upbeat Nystagmus; Pancreatic Endocrine Carcinoma; Anti-Hu - Associated Paraneoplastic Encephalitis
74 905-1-videoUnilateral Horizontal Gaze PalsyThis 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...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...
75 906-2Progressive External OphthalmoplegiaThe patient is an 18 year old girl, first seen in 1990 with a 6 year history of progressive ptosis. In 1986, at age 14, she was seen by an ophthalmologist and pediatric neurologist and investigated. Myasthenia Gravis was ruled out by a negative Tensilon test, negative anti-acetylcholine receptor ...Bilateral Ptosis; Facial Weakness; Complete External Ophthalmoplegia; Normal Pupils; Bilateral Progressive External Ophthalmoplegia (PEO); Mitochondrial Myopathy
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