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151 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...
152 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...
153 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis is a 32-year-old HIV-positive man with anterior uveitis, vitritis, and bilateral papillitis from syphilis. With intravenous penicillin treatment, the optic discs and vision returned to normal.
154 Isolated Optic Neuritis/NeuropathyJohn A. Charley, MDSeveral Primary Mutations result in Leber's hereditary optic neuropathy, including mitochondrial deletions at positions 11778, 3460, and 14484. Although the 11778 is the most common mutation, the 11484 has the best prognosis for spontaneous recovery. This case exhibits the 3460 mutation.
155 Isolated Optic Neuritis/NeuropathyJohn A. Charley, MDSeveral Primary Mutations result in Leber's hereditary optic neuropathy, including mitochondrial deletions at positions 11778, 3460, and 14484. Although the 11778 is the most common mutation, the 11484 has the best prognosis for spontaneous recovery. This case exhibits the 3460 mutation.
156 Isolated Optic Neuritis/NeuropathyJohn A. Charley, MDSeveral Primary Mutations result in Leber's hereditary optic neuropathy, including mitochondrial deletions at positions 11778, 3460, and 14484. Although the 11778 is the most common mutation, the 11484 has the best prognosis for spontaneous recovery. This case exhibits the 3460 mutation.
157 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.
158 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.
159 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.
160 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...
161 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...
162 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...
163 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...
164 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...
165 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...
166 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...
167 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...
168 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDA 42-year old woman presented with a history of severe brow pain and 4 days of progressive visual loss OD. There was no increased pain on ocular rotation. Aside from heavy menses, she denied any significant past medical history. Her examination revealed acuity NLP OD, 20/25 OS; color vision 9/10 OS;...
169 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDA 42-year old woman presented with a history of severe brow pain and 4 days of progressive visual loss OD. There was no increased pain on ocular rotation. Aside from heavy menses, she denied any significant past medical history. Her examination revealed acuity NLP OD, 20/25 OS; color vision 9/10 OS;...
170 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...
171 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...
172 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDA 42-year old woman presented with a history of severe brow pain and 4 days of progressive visual loss OD. There was no increased pain on ocular rotation. Aside from heavy menses, she denied any significant past medical history. Disease/Diagnosis: Syphilitic optic neuritis/perineuritis, fundus, OS -...
173 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 ...
174 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...
175 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...
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