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101 One_and_Half_SyndromeShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis 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 numbn...
102 Paraneoplastic_OpsocolonusShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis patient is the index case of the Anti-Ri antibody, published in Annals of Neurology in 1988 (4). The Anti-Ri antibody is recognized to be a paraneoplastic marker in patients with breast and gynecological malignancies (10). The history of this case is particularly important because she was initi...
103 Progressive_Supranuclear_PalsyShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/316, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/241, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/32, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/81, http://content.lib.utah.edu/cdm/ref/...
104 Multiple_SclerosisShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe patient is a 56 year old woman who presented in 1982, at the age of 48, with a one week history of painless loss of vision in the left eye. Past History: Negative for a previous attack of optic neuritis or transient neurological symptoms. Family History: Negative for CNS disease Neuro-ophthalmol...
105 Claudes_SyndromeShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe patient is a 76 year old woman who woke one morning unable to see out of her right eye because of ptosis. She came to the Massachusetts General Hospital emergency room and was admitted. Neurological Examination: Right third nerve palsy involving the pupil Ataxia of the left hand on finger-nose t...
106 Pendular_OscillationsShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis 37 year old woman has had progressive multiple sclerosis (MS) affecting the cerebellum and brainstem for 6 years. Neurological examination: Titubation Dysarthria Incoordination of the extremities Ataxic gait Spastic paraparesis with generalized hyperreflexia and extensor plantar responses. Neur...
107 Downbeat_Nystagmus_PANShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis patient carries a diagnosis of multiple sclerosis. See also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/317
108 Migraine_Visual_AuraShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe patient is a 9 year old right handed boy who developed headaches in 1993 at the age of 8. At that time he told his mother that he had bad headaches starting at the back of the head, usually bioccipital, spreading over the top of the head to his forehead. The headaches were short in duration last...
109 Selective_Saccadic_PalsyShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis 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 awakening...
110 Ocular_Motor_Apraxia_guest_lectureShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalSee 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/252
111 Thalamic_InfarctShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe patient is a 64 year old man with no major past medical history who, on the day of admission, suddenly developed loss of vision in both eyes and then was unable to open his eyes on his own unless he used his hands. Holding his eyelids open his vision was very blurry. Within minutes he lost consc...
112 Multiple_Sclerosis_LateropulsionShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis 44 year old woman has a diagnosis of Multiple Sclerosis. See also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/281
113 Constructional_ApraxiaShirley 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 right handed woman who presented in November 1995 with the sudden onset of impaired coordination of visual and motor skills following an inner right ear infection. One of her problems was difficulty sitting on a chair as she tended to place her body incorrectly. By late ...
114 Charles_Bonnet_SyndromeShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe 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...
115 Alexia_without_AgraphiaShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe 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...
116 Parkinsons_Disease_guest_lectureShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/93 and http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/298
117 Supranuclear_Paralysis_of_DowngazeShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalJohn Trojanowski and I published this case in Neurology in 1980.(12) At that time, it was one of the first of five reports in the literature of the pathological localization of lesions in the midbrain that are responsible for selective supranuclear paralysis of downgaze. This case is of particular i...
118 CNS_LymphomaShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe 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 ...
119 Parkinsons_DiseaseShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/298 and http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/93
120 Midbrain_HemorrhageShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe 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 the loc...
121 Saccades_guest_lectureShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe video of the normal eye movement examination was made with the assistance of Dr. Terrence Millette, a neurologist and former Fellow with me in 1985-1986. Introduction to the Saccadic System Saccades are fast eye movements that bring the image of an object of interest onto the fovea. They consist...
122 Third_Nerve_PalsyShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe patient is a 50 year old man with Type II Diabetes who presented to an outside hospital in September 1996 with ptosis and an inability to open the right eye. Five months prior to admission (PTA), he had flu-like symptoms with mild fever, sinus congestion and diffuse myalgia in the chest, abdomen...
123 NeuroblastomaShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe 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 kg. T...
124 Familial_Amyotrophic_Lateral_SclerosisShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThis 58 year old woman was referred to Dr. Robert Brown in March 1995 for evaluation of slurred speech. She remained under his care until her death. On examination she had signs of a pseudobulbar palsy: Dysarthria and dysphagia Diminished palatal movement with positive gag bilaterally Diminished rap...
125 Brainstem_Cavernous_AngiomaShirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General HospitalThe 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 ...
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