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126 Selective Saccadic PalsyShirley H. Wray, MD, PhD, FRCPThis 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...Selective Saccadic Palsy After Cardiac Surgery; Supranuclear Gaze Palsy; Ocular Motility; Bilateral Horizontal Gaze Palsy Hypoxia; Pontine Hypoxia; Cerebral Hypoxia
127 Cavernous AngiomaShirley H. Wray, MD, PhD, FRCPThe patient is a 19 year old sophomore who presented in 1983 with numbness of the left hand, involving initially just the fingers, and numbness and weakness of the right side of the face. He described the numbness in his hand as if it was "intensely asleep". The facial numbness involved the perioral...Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Pendular Vertical Oscillations; Facial Palsy; Fisher's One-and-a-Half Syndrome; Pontine Hemorrhage; Cavernous Angioma; Unilateral Gaze Palsy Hemorrhage; Abducting Nystagmus; Fac...
128 Brainstem Cavernous AngiomaShirley H. Wray, MD, PhD, FRCPThe 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 ...Upbeat Nystagmus; Lid Nystagmus; Horizontal Gaze Evoked Nystagmus; Hiccup; Medullary Hemorrhage; Cavernous Angioma; Bilateral Lid Nystagmus; Bilateral Horizontal Gaze Palsy Hemorrhage; Primary Position Upbeat Nystagmus; Medulla Hemorrhage; Medulla
129 Tauopathies (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/256, 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/collection/ehsl-shw/id/315, http://content.lib.utah.edu/cdm/ref/...Global Supranuclear Vertical Gaze Palsy; Convergence absent; Prominent Stare; Slow Hypometric Horizontal Saccades; Slow Horizontal Pursuit; Vertical Oculocephalic Reflex Normal; Positive Glabella Tap; Progressive Supranuclear Palsy; Steele Richardson Olszewski Syndrome; Supranuclear Paralys...
130 Tauopathies: A Contemporary Way to Consider a Set of Neurodegenerative Disease Based on Molecular SignatureJohn Growdon, MDSlideshow describing condition.CNS - Degeneration Congenital Ocular Motor Apraxia; Convergence absent; Convergence Insufficiency; Global Supranuclear Vertical Gaze Palsy; Head Thrust; Lid Retraction; Positive Glabella Tap; Progressive Supranuclear Palsy - Tauopathy; Progressive Supranuclear Palsy; Prominent Stare; Pursuit Upgaze...
131 Downbeat NystagmusShirley H. Wray, MD, PhD, FRCPThis 58 year old engineer was referred by his neurologist for evaluation of periodic episodes of difficulty focusing and blurred vision for 8 years. In 1981 whilst sightseeing in Newport, he became acutely aware of difficulty focusing and blurry vision. The symptoms lasted for twenty minutes and the...Downbeat Nystagmus; Oscillopsia; Primary Position Downbeat Nystagmus
132 Ocular Motor ApraxiaShirley H. Wray, MD, PhD, FRCPPresentation covering an overview of Ocular Motor Apraxia. See 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/252Congenital Ocular Motor Apraxia; Head Thrust
133 Whipple's DiseaseShirley H. Wray, MD, PhD, FRCPA PowerPoint presentation describing Whipple's Disease.Absent Convergence; Bilateral Lid Nystagmus; CNS Whipple's Disease; Pendular Vergence Oscillations; Somnolence; Supranuclear Paralysis of Up and Downgaze Infection-Whipple's Disease; Supranuclear Paralysis of Up and Downgaze; Tropheryma Whippelii - Infection; Vertical Gaze Palsy (c)
134 Migraine Visual AuraShirley H. Wray, MD, PhD, FRCPThe 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...Migraine Visual Aura without Headache; Metamorphopsia; Macropsia - Hemi-macropsia; Alice in Wonderland Syndrome; Occipital Lobe; Visual Phenomena
135 Thalamic Stroke and Disordered Sleep (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/299, http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/114, and http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/117Somnolence; 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...
136 Upbeat NystagmusShirley H. Wray, MD, PhD, FRCPThe patient, a 36 year old Italian, presented in October 1967, at the age of 27, with acute dizziness and ataxia. He was evaluated in Rome. A pneumoencephalogram showed hydrocephalus, attributed to arachnoiditis, and a ventriculo-atrial shunt was placed. Three months post shunt placement he had a re...Upbeat Nystagmus; Saccadic Hypermetria; Saccadic Pursuit; Square Wave Jerks; Oscillopsia; Cerebellar Astrocytoma; Primary Position Upbeat Nystagmus; Horizontal Saccadic Dysmetria
137 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.Radiation Retinopathy
138 Brain Control of Horizontal Saccadic Eye MovementsShirley H. Wray, MD, PhD, FRCPPowerPoint lecture describing brain control of horizontal saccadic eye movements.Acquired Ocular Motor Apraxia; Alzheimer's Disease with Mild Extrayramidal Signs; Cerebral Cortex; CNS Degeneration; Complete Paralysis of Voluntary Horizontal Saccades on Command to Look Left; Facial Tremor; Frontotemporal Dementia; Impaired Pursuit; Inability to Make a Refixation Saccade on Comma...
139 Lid Lag (PPT)Shirley H. Wray, MD, PhD, FRCPThe classical eye signs of thyroid associated ophthalmopathy (TAO) of Graves' Disease is illustrated by case ID925-4. This 50 year old woman with TAO is included in the collection because she illustrates very well lid lag (persistent elevation of the upper eyelid in downgaze) - von Graefe sign Eyeli...Lid Lag; Bilateral Exophthalmos; Restrictive Orbitopathy of Graves' Disease
140 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.Pseudotumor Cerebri/Papilledema; Edema; Papilledema and Resolution
141 Bilateral PtosisShirley H. Wray, MD, PhD, FRCPA PowerPoint slideshow of diagnosed patients.Bilateral Ptosis; Facial Weakness; Full Eye Movements; MuSK Antibody Myasthenia Gravis; Tongue Atrophy; Myasthenia Gravis
142 Transient Monocular Blindness (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPSee also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/293 and http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/96Retinal Emboli; Transient Monocular Blindness; Ocular Stroke; Transient; Transient Visual Loss; Sunlight Provoked Transient Monocular Blindness; Low Pressure Retinopathy; Ipsilateral Internal and External Carotid Occlusive Disease; Ischemic Eye Syndrome; Retinal Stroke; Ocular Ischemic Sy...
143 Ocular Motor ApraxiaShirley H. Wray, MD, PhD, FRCPPresentation covering an overview of Ocular Motor Apraxia. See 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/252Congenital Ocular Motor Apraxia; Head Thrust; Ocular Motor Apraxia
144 Alexia Without AgraphiaShirley H. Wray, MD, PhD, FRCPThe 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...Pure Alexia; Color Anomia; Right Homonymous Hemianopia; Alexia Without Agraphia; Infarct of the Left Visual Cortex and Splenium of the Corpus Callosum; Disconnection Syndrome; Occipital Infarct
145 Visual NeglectShirley H. Wray, MD, PhD, FRCPThe 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
146 Constructional ApraxiaShirley H. Wray, MD, PhD, FRCPSlideshow describing condition.Apraxia of the Left Hand; Constructional Apraxia; Degenerative CNS Disease; Dressing Apraxia; Progressive Lobar Atrophy; Right Parietal Lobe
147 Charles Bonnet SyndromeShirley H. Wray, MD, PhD, FRCPThe 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...Occipital Lobe; Visual Hallucinations; Release Hallucinations; Charles Bonnet Syndrome
148 Bilateral Internuclear OphthalmoplegiaShirley H. Wray, MD, PhD, FRCPThis patient was seen at the Yale Eye Center at the age of 37. She had a long history of multiple sclerosis. At age 22, she had an acute attack of optic neuritis in the left eye which recovered fully within three weeks. Some months later she had a recurrent episode in the same eye, which also recove...Bilateral Internuclear Ophthalmoplegia; Pendular Horizontal Oscillations; Lid Nystagmus; Upbeat Nystagmus; Botulinum Toxin Therapy; Multiple Sclerosis; Horizontal Pendular Nystagmus; Gaze Evoked Upbeat Nystagmus; Abducting Nystagmus
149 Internuclear Ophthalmoplegia in Childhood (Guest Lecture)Shirley H. Wray, MD, PhD, FRCPThis case was reported by Cogan DG and Wray SH. Internuclear ophthalmoplegia as an early sign of brain tumor. Neurology 1970; 20:629-633. The patient is Case 1. He is a 4 ½ year old boy whose parents noted that the right eye had been "drifting" for four months. On examination the only significant f...Bilateral Internuclear Ophthalmoplegia; Upbeat Nystagmus; Medulloblastoma; Abducting Nystagmus
150 Supranuclear Paralysis of Vertical GazeShirley H. Wray, MD, PhD, FRCPThis 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 aro...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...
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