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126 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDAt age 41, in 1984, this woman, who grew up in the Ohio River Valley, had 3 days of ocular pain OD, and her vision declined to 20/80 OD she has had no visual changes since, nor has she had any other neurologic symptoms. The ""presumed"" diagnosis is optic neuropathy in presumed ocular histoplasmosis...
127 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 57-year-old man had a neuro-ophthalmology consult, requested the night before his 2-cm pituitary tumor was to be resected. His examination revealed his acuities to be 20/70 OU, with a visual field not consistent with chiasmal compression. The fundus appearance, with peripheral salt and pepperin...
128 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...
129 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...
130 Neuro-Ophthalmic Imaging-MRIScott Forman, MDThis 23-year-old right-handed man had a history of idiopathic recurrent optic neuritis. The patient presented with acuity of 20/400 OD and 20/100 OS, with a central scotoma OD and a complete temporal defect OS. MRI with fat suppression and gadolinium revealed enhancement of the intracranial nerve an...
131 Neuro-Ophthalmic Imaging-MRIScott Forman, MDThis 23-year-old right-handed man had a history of idiopathic recurrent optic neuritis. The patient presented with acuity of 20/400 OD and 20/100 OS, with a central scotoma OD and a complete temporal defect OS. MRI with fat suppression and gadolinium revealed enhancement of the intracranial nerve an...
132 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_35. This is a fundus photo.
133 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_34, and 94_35. This is a fundus photo.
134 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_33, 94_34, and 94_35. This is a fundus photo.
135 Optic NeuropathiesDaniel M. Jacobson MDThis 28-year-old otherwise-healthy woman was referred to for treatment of what was thought to be optic neuritis OD. Three weeks earlier she had noted a dark inferior scotoma OD that progressed to involve fixation over the next 10-12 days. She experienced photopsias OD at the onset. She had no viral ...
136 Optic NeuropathiesDaniel M. Jacobson MDThis 28-year-old otherwise-healthy woman was referred to for treatment of what was thought to be optic neuritis OD. Three weeks earlier she had noted a dark inferior scotoma OD that progressed to involve fixation over the next 10-12 days. She experienced photopsias OD at the onset. She had no viral ...
137 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...
138 Neuro-Ophthalmic Vascular DiseaseLarry P. Frohman, MDThis 27-year-old woman had no past ocular history and presented with 3 weeks of redness OS that has been treated by the referring doctor as allergic conjunctivitis. She was referred for evaluation when she developed binocular diplopia. Her past medical history included phlebitis and one miscarriage ...
139 Neuro-Ophthalmic Vascular DiseaseLarry P. Frohman, MDThis 27-year-old woman had no past ocular history and presented with 3 weeks of redness OS that has been treated by the referring doctor as allergic conjunctivitis. She was referred for evaluation when she developed binocular diplopia. Her past medical history included phlebitis and one miscarriage ...
140 Ocular Manifestations of Congenital/Inherited DiseasesSteven Galetta, MDThis 21-year-old woman had a 2-year history of blurred vision. A computerized visual field demonstrated a temporal defect OS. MRI confirmed a chiasmal mass lesion. The pathology was consistent with hemangioblastoma. Further workup revealed retinal angiomas and multiple other hemangioblastomas of the...
141 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...
142 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...
143 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...
144 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.
145 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.
146 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.
147 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...
148 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...
149 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...
150 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...
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