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101 Progressive External OphthalmoplegiaIn 1995 I published this case alongside eleven personal cases, three with the Kearns-Sayer Syndrome (KSS) and five with Progressive External Opthalmoplegia (PEO). Am J of Neuroradiol:16 (5);1167-1173. The patient was under the care of Dr. Raymond Adams from age 13 years. In 1991, at age 40 years...Image/MovingImage
102 Supranuclear Paralysis of UpgazeThe patient is a 49 year old woman who was in good health until January 17, 1991. When, at work one morning, she had an acute attack of light headedness and double vision and collapsed on the floor without loss of consciousness. She developed a severe retro-orbital headache. She was taken to t...Image/MovingImage
103 Palatal TremorThe patient is a 60 year old woman with insulin dependent diabetes mellitus. She was legally blind as a result of diabetic retinopathy and bilateral vitreous hemorrhage. In 1987, she was admitted to her local hospital with slurred speech and a right hemiparesis progressing over a period of three d...Image/MovingImage
104 Pendular Vertical OscillationsIn 1996 this 50 year old woman had the acute onset of tingling in the left arm and mild ataxia. In 1974 because of progressive symptoms and the onset of double vision attributed to a bilateral sixth nerve palsy, she consulted a neurologist at an outside hospital. She was given a diagnosis of Multip...Image/MovingImage
105 Fourth Nerve PalsyThe patient is a 64 year old engineer who noted whilst driving around Thanksgiving time double vision with one image on top of the other. Vertical double vision persisted and he was referred to the Massachusetts General Hospital for evaluation. Past History: 1991 Hyperthyroidism with Graves' Dise...Image/MovingImage
106 Third 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...Image/MovingImage
107 Release HallucinationsThe 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 c...Image/MovingImage
108 Downbeat NystagmusThe patient is a 59 year old woman who carried a diagnosis of: 1. Congenital anomaly of the occipito-cervical junction with occipitalization of the C1 ring 2. Basilar invagination with Chiari Type I 3. A syrinx in the center of the cervical-thoracic spinal cord extending from C2 to T4 In 1957, at ag...Image/MovingImage
109 Convergence InsufficiencyThe 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 w...Image/MovingImage
110 Upbeat NystagmusThe patient is a 50 year old woman who presented in November 1977 with a transient facial droop, nystagmus, diplopia, dysarthria and vertigo. She was admitted to New England Tufts Medical Center and had an extensive workup including an electroencephalogram, first generation CT brain scan, angiogram ...Image/MovingImage
111 Supranuclear Paralysis of UpgazeThe patient is a 37 year old man with a history of intravenous drug abuse, AIDS, and tuberculosis. He presented with a chief complaint of unsteadiness walking for two weeks and vertical diplopia for four days. Past History: Human immunodeficiency Virus (HIV) positive When his CD4 lymphocyte count b...Image/MovingImage
112 Sixth Nerve PalsyThe patient is a 45 year old pharmaceutical executive who, nine days prior to admission, flew back from San Francisco after a hectic business trip feeling jet lagged and fatigued. Inspite of this, four days later, he did a day trip to New York. On the following morning, a Saturday, he awoke with ...Image/MovingImage
113 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
114 Fisher's One and a Half SyndromeThe patient is a 62 year old right handed man, status post myocardial infarction in 1989 and on Coumadin. In 1993 he presented with a history of three separate TIAs 1. Instantaneous perioral tingling and/or numbness lasting less than 1 minute. 2. Episodic numbness of the right hand and foot lasti...Image/MovingImage
115 Fourth Nerve PalsyThe patient is a 32 year old, left handed chemistry teacher who presented with intermittent vertical double vision. In August 1992 she noted, particularly late in the evening when reading in bed, vertical double vision. The images were one on top of the other and on occasions one image was slig...Image/MovingImage
116 Bilateral Sixth Nerve PalsyThe patient is a 22 year old man. Five days prior to admission (PTA) he developed a sore throat, non-productive cough and a temperature of 99.8 during the day and chills and diaphoresis at night. Four days PTA he had double vision in primary gaze, difficulty with his balance and gait, and a tinglin...Image/MovingImage
117 Bilateral Ptosis Facial DiplegiaThe patient is a 47 year old attorney who was transferred from an outside hospital to the Massachusetts General Hospital (MGH) for treatmebnt of the Miller Fisher variant of the Guillian Barré syndrome (GBS). On the morning of September 14, 1993, the patient awoke feeling dizzy and he was unsteady ...Image/MovingImage
118 Essential Palatal TremorThe patient is a 25 year old meteorologist from Tennessee who came to Boston in the summer of 1992 to vacation with his family on the Cape. His illness started with flu-like symptoms, low grade fever from 99 to 100F, sweating and episodes of light headedness associated with occasional nausea, indige...Image/MovingImage
119 Paraneoplastic Ocular FlutterThe patient is a 58 year old woman with known hypertension. In 1994, two weeks prior to admission she had a dramatic change in behavior with insomnia, agitation and depression. This was accompanied by "ringing of hands and anxiety for no apparent reason". She became anorexic, lost 15 pounds ...Image/MovingImage
120 Fisher's One and a Half SyndromeThis 44 year old woman presented in 1973 with an acute attack of optic neuritis in the right eye that fully recovered after a course of ACTH therapy. In 1991, 18 years later, she developed unsteadiness of gait, "walking like a chicken", stiff legs that jerked spontaneously in bed at night, and num...Image/MovingImage
121 Paralysis of ConvergenceThe patient is a 25 year old man with a long history of headaches due to hydrocephalus. He carries the following diagnoses: 1. Hydrocephalus 2. Aqueduct stenosis 3. Low grade glioma involving the quadrageminal plate 4. Seizures The patient first came to neurological attention at the age of 12 whe...Image/MovingImage
122 Paraneoplastic Opsoclonus; Downbeat NystagmusThe patient is Case 27-1995 Case Records of the Massachusetts General Hospital (New Eng. J Medicine 1995, 333:579-586). The discusser was Dr. Elizabeth Engle, Associate Professor of Neurology, Harvard Medical School. The baby girl was born after a 30 week gestation, with a birth weight of 1.25 k...Image/MovingImage
123 Supranuclear Paralysis of UpgazeThis 84 year old woman carried the following diagnoses: 1. Extrapyramidal movement disorder; Parkinson's disease vs. Progressive supranuclear palsy 2. Hypertension 3. Recurrent left Bell's palsy In 1992, the patient and her family noted that she was drifting to the right when driving. She progress...Image/MovingImage
124 Congenital NystagmusThis 11 year old Italian boy was referred for evaluation of nystagmus. Emanuel is the second son in a family of two and his older brother, age 13, had no visual problem. Emanuel was born at term, normal delivery, birth weight 9 pounds. Neonatal and infant development was perfectly normal. A pedia...Image/MovingImage
125 Benign Neonatal Ocular FlutterShortly after birth, this baby was noted to have "jiggling eyes" by his mother. He was in good general health and neurologically intact. Cogan and I saw the baby and Cogan made the diagnosis of neonatal ocular flutter. In 1954 Cogan first used the term "ocular flutter" to describe a rare disorder o...Image/MovingImage
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