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126 Neuro-Ophthalmic Vascular DiseaseSteven A. Newman, MDOcclusion 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...
127 Neuro-Ophthalmic Consequences of TherapyLarry P. Frohman, MDThis woman presented at age 52, 3 years after radiation therapy for a salivary gland carcinoma extending into the right maxillary sinus. She had received 6000 rads in 30 fractions over 45 days. She presented with 3 weeks of visual loss, with acuity of 20/30, normal color plates, normal fields, and n...
128 Neuro-Ophthalmic Consequences of TherapyLarry P. Frohman, MDThis woman presented at age 52, 3 years after radiation therapy for a salivary gland carcinoma extending into the right maxillary sinus. She had received 6000 rads in 30 fractions over 45 days. She presented with 3 weeks of visual loss, with acuity of 20/30, normal color plates, normal fields, and n...
129 Systemic Disorders With Optic Nerve and Retinal FindingsRobert F. Saul, MDThis patent has known pseudoxanthoma elasticum (an uncommon elastic tissue disorder characterized by plaque-like skin folds [plucked chicken skin], and degeneration of collagen fibers involving multiple systems, including the GI tract and heart), angioid streaks, and optic disc drusen.
130 Systemic Disorders With Optic Nerve and Retinal FindingsRobert L. Lesser, MDIntraocular lymphoma may present with an unexplained vitritis, optic disc infiltration, or choroidal infiltration. One unusual manifestation of large-cell lymphoma is this leopard-spot appearance. Pair with 94_32, 94_33, and 94_34. This is a fluorescein angiogram.
131 Neuro-Ophthalmic Manifestations of Brain TumorsJacqueline A. Leavitt, MDChordomas of the clivus may result in diplopia due to a sixth nerve palsy. The sixth nerve runs up the clivus and may be the presenting manifestation of the lesion. Pair with Images 97_33, 97_34, and 97_35.
132 Optic NeuropathiesDaniel M. Jacobson MDThis 34-year-old otherwise-healthy woman was referred for a neuro-ophthalmologic consultation for unexplained loss of vision OD following head trauma. Two months earlier, she was involved in a motor vehicle accident that resulted in a closed head injury complicated by a spontaneously resolving small...
133 Optic NeuropathiesDaniel M. Jacobson MDThis 34-year-old otherwise-healthy woman was referred for a neuro-ophthalmologic consultation for unexplained loss of vision OD following head trauma. Two months earlier, she was involved in a motor vehicle accident that resulted in a closed head injury complicated by a spontaneously resolving small...
134 Optic NeuropathiesDaniel M. Jacobson MDThis 34-year-old otherwise-healthy woman was referred for a neuro-ophthalmologic consultation for unexplained loss of vision OD following head trauma. Two months earlier, she was involved in a motor vehicle accident that resulted in a closed head injury complicated by a spontaneously resolving small...
135 Optic Tract Syndrome Due to Carotid Artery DolichoectasiaLarry P. Frohman, MDThis 43-year-old man was referred for evaluation of 6 months of visual loss OU. In retrospect, he had noticed increasing difficulty with his tennis game dating back over 3 years, as balls would pass him unexpectedly when hit to his backhand (left) side. The patient did not think this was progressive...
136 Neuro-Ophthalmic Vascular DiseaseMark J. Kupersmith, MDA 9-year-old boy had recurrent ischemic episodes that had begun 2 years prior to evaluation. A significant right hemiparesis and a significant speech, learning, and memory disorder were present. His noncontrast axial view CT scan demonstrated multiple cerebral infarcts. Cerebral angiography revealed...
137 Neuro-Ophthalmic Vascular DiseaseMark J. Kupersmith, MDA 9-year-old boy had recurrent ischemic episodes that had begun 2 years prior to evaluation. A significant right hemiparesis and a significant speech, learning, and memory disorder were present. His noncontrast axial view CT scan demonstrated multiple cerebral infarcts. Cerebral angiography revealed...
138 Neuro-Ophthalmic Vascular DiseaseMark J. Kupersmith, MDA 9-year-old boy had recurrent ischemic episodes that had begun 2 years prior to evaluation. A significant right hemiparesis and a significant speech, learning, and memory disorder were present. His noncontrast axial view CT scan demonstrated multiple cerebral infarcts. Cerebral angiography revealed...
139 Ocular Manifestations of Systemic DisordersDaniel M. Jacobson MDThis 59-year-old man had a 4-week history of malaise, myalgias, night sweats, weight loss, fatigue, and generalized headaches, and a few days before admission he developed a red eye OS secondary to exposure keratitis associated with a left-sided seventh nerve palsy. Subsequent evaluation disclosed a...
140 Chiasmal SyndromesLarry P. Frohman, MDA 50-year-old right-handed woman with no significant past medical history underwent liposuction on her abdomen, hips, and thighs under general anesthesia. Her height and weight were 167 cm and 63 kg, respectively. Subcutaneous fat was injected with 2.5 L of 0.05% xylocaine and 1:10,000,000 epinephri...
141 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDPatients with hypoplasia of the optic nerve may have normal or subnormal visual acuity or visual field. The condition may be unilateral or bilateral. Optic nerve hypoplasia is usually idiopathic, but maternal diabetes, or maternal use of anti-epileptic drugs or alcohol are predisposing factors. Opti...
142 Neuro-Ophthalmic Consequences of TherapyDon Bienfang, MDAn elderly woman was first seen in 1991, after being on Plaquenil (Hydroxychloroquine Sulfate) for 5 to 6 years, with a new symptomatic disturbance in her reading. Because her blue/yellow color perception was disturbed, and because she had symptoms, the medication was stopped. However the fundi and ...
143 Ocular Manifestations of Congenital/Inherited DiseasesJacqueline A. Leavitt, MDThis 22-year-old woman has neurofibromatosis, type 2. Acuity, color plates, pupillary responses, slit-lamp examination, IOP, fields, and funduscopy are all normal. There is a 3 mm proptosis OS. The patient has recently undergone gamma knife for the acoustic tumor, and she has residual facial nerve p...
144 Chiasmal SyndromesLarry P. Frohman, MDA 50-year-old right-handed woman with no significant past medical history underwent liposuction on her abdomen, hips, and thighs under general anesthesia. Her height and weight were 167 cm and 63 kg, respectively. Subcutaneous fat was injected with 2.5 L of 0.05% xylocaine and 1:10,000,000 epinephri...
145 Chiasmal SyndromesLarry P. Frohman, MDA 50-year-old right-handed woman with no significant past medical history underwent liposuction on her abdomen, hips, and thighs under general anesthesia. Her height and weight were 167 cm and 63 kg, respectively. Subcutaneous fat was injected with 2.5 L of 0.05% xylocaine and 1:10,000,000 epinephri...
146 Optic NeuropathiesLarry P. Frohman, MDThis healthy 29-year-old man with dense amblyopia OS presented with a foreign-body sensation OS and further visual loss in his amblyopic eye. He was noted to have bilateral disc edema and lesions in the left eye consistent with unilateral acute multifocal placoid pigment epitheliopathy (AMPPE). He r...
147 Optic NeuropathiesLarry P. Frohman, MDThis healthy 29-year-old man with dense amblyopia OS presented with a foreign-body sensation OS and further visual loss in his amblyopic eye. He was noted to have bilateral disc edema and lesions in the left eye consistent with unilateral acute multifocal placoid pigment epitheliopathy (AMPPE). He r...
148 Optic NeuropathiesLarry P. Frohman, MDThe 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...
149 Optic NeuropathiesLarry P. Frohman, MDThe 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...
150 Neuro-Ophthalmic Manifestations of Brain TumorsSteven Galetta, MDThe patient is a 45-year-old recluse found to harbor this frontal lobe mass. Remarkably, this patient had only mild bilateral optic neuropathies with visual acuities in the 20/25 range. This right disc was mildly swollen and the left mildly pale. He could not fit into the fundus camera for disc phot...
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