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IdentifierTitleHistorySubject
126 939-4Migraine Visual AuraThe patient is a 73 year old retired teacher who was referred in 1993 for a second opinion regarding treatment of episodic visual hallucinations. As a school boy in junior school, he began to experience transient episodes of a spot appearing in the right lower homonymous quadrant of his field of vi...Migraine Visual Aura; Occipital Lobe; Visual Phenomena
127 939-6Supranuclear Paralysis of UpgazeThe patient is a 71 year old woman who was admitted to the Cardiac Unit following an acute "rush to the head", diaphoresis, and palpitations. She felt she was about to faint. She described seeing gold rings in her vision for a few minutes. Past History: Partial complex seizures since 1987. Th...Supranuclear Paralysis of Upgaze Infarct; Bilateral Lid Retraction - Collier's Sign; Convergence Retraction Nystagmus; Vertical Oculocephalic Reflex Normal; Skew Deviation; Light/Near Dissociation of the Pupils; Pretectal Syndrome; Top of the Basilar Syndrome; Midbrain Infarct; Supranuclear Paralysi...
128 939-8Bilateral Sixth Nerve PalsyThis patient is a 62 year old woman with a six month history of double vision and difficulty walking. In August 1996, she first noted her right upper eyelid twitching followed by dizziness, nausea and vomiting. Soon after her voice became "shaky" and she experienced mild difficulty walking. She...Bilateral Sixth Nerve Palsy; Bilateral Esotropia; Paraneoplastic Opsoclonus/Flutter; Paraneoplastic Cerebellar Syndrome; Carcinoma of the Breast; Paraneoplastic Opsoclonus
129 940-1Fourth 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...Hypertropia; Superior Oblique Paresis; Inferior Oblique Overaction; Fourth Nerve Palsy; Trochlear Nerve; Bielchowsky Test; Head Tilt; Fourth (Trochlear)
130 940-3Third Nerve PalsyThis patient is a 46 year old woman from Portugal who was admitted to the Massachusetts General Hospital in September 1986 with ophthalmoplegia of the left eye (OS) and signs of aberrant reinnervation of the third nerve. She presented, in August 1985, with an episode of diplopia. The diplopia was s...Ptosis; Unilateral Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Paresis of Abduction; Sixth Nerve Palsy; Oculomotor Nerve; Cavernous Sinus Meningioma; Cavernous Sinus Syndrome; Unilateral Oculomotor Third Nerve Palsy; Unilateral Sixth Nerve Palsy
131 941-2Bilateral Internuclear OphthalmoplegiaThis 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 ...Bilateral Internuclear Ophthalmoplegia; Pendular Horizontal Oscillations; Lid Nystagmus; Upbeat Nystagmus; Botulinum Toxin Therapy; Multiple Sclerosis; Horizontal Pendular Nystagmus; Gaze Evoked Upbeat Nystagmus; Abducting Nystagmus
132 941-3Pendular Horizontal OscillationsThis 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. ...Pendular Horizontal Oscillations; Left Beating Nystagmus; Obtrusive Saccades; Bilateral Gaze Evoked Nystagmus; Saccadic Dysmetria; Oscillopsia; Titubation; Ataxia; Multiple Sclerosis; Primary Position Horizontal Nystagmus; Gaze Evoked Horizontal Nystagmus; Horizontal Saccadic Dysmetria
133 941-4Fisher's One and a Half SyndromeThe patient is a 56 year old woman who was seen by a Stroke Consult on the cardiac unit because she had difficulty opening her left eye and diplopia looking to the right. On examination she had ptosis OS and "a partial ophthalmoplegia" sparing the pupil. Diagnosis Partial left third nerve palsy....Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Fisher's One-and-a-Half Syndrome; Pontine Infarct; Unilateral Horizontal Gaze Palsy Infarct; Gaze Evoked Upbeat Nystagmus; Abducting Nystagmus
134 941-5Upbeat 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 ...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
135 941-6Fisher'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...Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Fisher's One-and-a-Half Syndrome; Pontine Infarct; Unilateral Horizontal Gaze Palsy Infarct; Abducting Nystagmus
136 942-2Convergence 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...Blepharoclonus; Convergence Insufficiency; Slow Hypometric Horizontal Saccades; Saccadic Breakdown of Smooth Pursuit; Parkinson's Disease - Dopamine Deficiency
137 942-3Upbeat NystagmusThe patient is a 36 year old Korean doctor who arrived from Korea in November 1994. On 12/25/94 she developed a painful erythematous eruption along her upper back extending toward her right shoulder. A physician diagnosed herpes zoster and prescribed a five day course of Acyclovir with good resolut...Upbeat Nystagmus; Horizontal Gaze Evoked Nystagmus; Opsoclonus; Bulbar Palsy; Post Infectious Brainstem Encephalitis; Cervical Myelitis; Bilateral Lid Nystagmus; Primary Position Upbeat Nystagmus
138 942-5Alexia Without AgraphiaThe 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...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
139 943-1Pendular 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...Pendular Vertical Oscillations; Lid Nystagmus; Bilateral Sixth Nerve Palsy; Bilateral Horizontal Gaze Palsy; Palatal Tremor (Myoclonus); Pontine Hemorrhage; Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillian Mollaret Triangle; Bilateral Horizontal Gaze Palsy Hemorrhage;...
140 943-3Supranuclear 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...Supranuclear Paralysis of Upgaze; Bilateral Lid Retraction - Collier's Sign; Convergence Retraction Nystagmus; Vertical Oculocephalic Reflex Normal; Skew Deviation; Pretectal Syndrome; Brainstem Encephalitis; Acquired Immune Deficiency Syndrome; CNS Infection; Supranuclear Paralysis of Upgaze Infect...
141 944-1Bilateral 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 ...Bilateral Ptosis; Total External Ophthalmoplegia; Facial Diplegia; Areflexia; Acute Inflammatory Demyelinating Neuropathy; Guillian Barre Syndrome - Miller Fisher Syndrome; Facial Weakness
142 944-5Bilateral 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...Voluntary Ptosis; Bilateral Sixth Nerve Palsy; Esotropia; Paresis of Conjugate Upgaze; Acute Inflammatory Demyelinating Neuropathy; Guillian Barre Syndrome - Miller Fisher Syndrome
143 944-6Supranuclear Vertical Gaze PalsyThis 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...Supranuclear Paralysis of Up and Downgaze Degeneration; Convergence Insufficiency; Slow Hypometric Horizontal Saccades; Saccadic Breakdown of Horizontal Pursuit; Bulbar Palsy; Familial Amyotrophic Lateral Sclerosis; Lou Gehrig's Disease; CNS - Degeneration; Superoxide Dismutase (SOD1) Gene
144 944-7Supranuclear Paralysis of DowngazeThe patient is a 62 year old man who, on getting out of bed one morning, found his eyes did not open fully. The right eye hardly opened at all and the left just a little. He staggered to the bathroom and started to floss his teeth and dropped a piece of floss on the floor. He felt unsteady bend...Supranuclear Paralysis of Downgaze; Vertical Oculocephalic Reflex Normal; Impaired Convergence; Exophoria; Ocular Tilt Reaction; Artery of Percheron; Midbrain Infarct; Supranuclear Paralysis of Downgaze Infarct
145 944-8Congenital Nystagmus: Eyes jump aroundThis 14 year old boy was born one month premature weighing 6 pounds 5 ounces. The top of his head failed to close until age 6. In addition he had only half a clavicle and stunted growth. Diagnosis: Cleidocranial dysostosis. He was referred by his endocrinologist for evaluation of difficulty ...Congenital Nystagmus; Horizontal Jerk Nystagmus; Optokinetic Nystagmus Absent; Infantile Nystagmus Syndrome; Oscillopsia; Cleidocranial Dysostosis
146 945-1Paralysis 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...Supranuclear Upgaze Palsy; Convergence Insufficiency; Horizontal Gaze Evoked Rotary Nystagmus; Hydrocephalus; Seizures; Brainstem Glioma
147 945-2Supranuclear Paralysis of DowngazeThe 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 con...Somnolence; Bilateral Ptosis; Supranuclear Paralysis of Downgaze; Vertical Oculocephalic Reflex Normal; Absent Convergence; Horizontal Gaze Evoked Nystagmus; Top of the Basilar Syndrome; Artery of Percheron; Thalamic Infarct; Supranuclear Paralysis of Downgaze Infarct; Thalamus Infarct; Downgaze Pal...
148 945-3Progressive 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...Bilateral Ptosis; Facial Weakness; Complete External Ophthalmoplegia; Bilateral Progressive External Ophthalmoplegia (PEO); Mitochondrial Myopathy; PEO Plus Deafness; Cerebellar Degeneration with Ataxia; Chronic Progressive External Opthalmoplegia
149 945-5Saccadic Initiation Deficit of Horizontal SaccadesThe patient is a 78 year old left handed woman with a diagnosis of a left parietal infarct in 1995, bilateral carotid artery stenosis and hypertension. She was first seen in August 1997 for evaluation of involuntary movements of the lower face in the setting of rapidly progressive dementia and was...Cerebral Cortex; Selective Saccadic Palsy - Acquired; Slow Initiation of Horizontal Saccades on Command; Slow Hypometric Horizontal Saccades; Supranuclear Saccadic and Pursuit Upgaze Palsy; Slow Initiation of Horizontal Purusit Tracking a Slow Target; Positive Glabella Tap; Facial Tremor; Alzheimer'...
150 946-1Progressive 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. This patient with KSS is still alive in 2009. In 1968, at the age of 15 he presented with a hi..."Bilateral Ptosis; Facial Weakness; Complete External Ophthalmoplegia; Bilateral Progressive External Ophthalmoplegia (PEO); Mitochondrial Myopathy; PEO Plus Atypical Retinitis Pigmentosa, Heart Block, Deafness, Proximal Myopathy and Cerebellar Degeneration with Ataxia; Kearns-Sayre Syndrome"
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