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TitleCreatorHistory
151 Lights OutJohn J. Brinkley; John J. Chen; Patricia A. Kirby; Reid A. Longmuir; Matthew J. ThurtellA 78 year-old man presented with a one-month history of progressive painless binocular vision loss. He had sustained head trauma without loss of consciousness three days prior to the onset of vision loss. On the morning of his presentation to us, he had awoken with complete binocular vision loss and...
152 Nobody's PerfectAlexander Ksendzovsky; Steven A. Newman, M.D., University of Virginia School of MedicineIn June of 2006 an 8 year old patient was referred for evaluation. Apparently at age 1 ½ she had developed headaches and was found to have a posterior fossa tumor. In El Salvador she was treated with shunting and chemotherapy plus radiation therapy for presumed medulloblastoma. She underwent a shun...
153 Under PressureNathan H. Kung; Collin M. McClelland; Gregory P. Van Stavern, MD, Associate Professor, Ophthalmology & Visual Sciences and Neurology, Washington University School of MedicineA 29-year-old woman was referred to neuro-ophthalmology clinic for 1 year of headaches and papilledema discovered 2 months earlier. She complained of recently blurred vision but no positional headache, pulsatile tinnitus, transient visual obscurations, or other neurologic issues. She used no medicat...
154 SpeakeasyJoseph G. Chacko, M.D., University of Arkansas; Marcus W. Moody; Harry H. Brown; Sarkis M. NazarianA 64 year-old Caucasian gentleman presented with an unusual complaint. He stated that if he touched the inside of his right cheek with his tongue, he felt a tingly sensation in his R eyebrow. This had started one month ago. He also complained of foreign body sensation and discomfort in the right eye...
155 Three Weeks in FloridaAndrew R. Carey; J. Antonio Bermudez-Magner; Sander R. Dubovy; Norman J. Schatz, M.D., Bascom Palmer Eye Institute; Linda L. Sternau; Byron L. LamA 36 year-old man presented with severe headaches, bilateral leg numbness, and bilateral decreased vision. He was born in Ecuador where he received BCG vaccination and immigrated to US at age 19. In 2005 he enrolled in nursing school and volunteered in homeless shelters. PPD was positive with a nega...
156 Growing SuspicionAngela M. Herro; Norman J. Schatz, M.D., Bascom Palmer Eye Institute; Linda L. Sternau; John R. Guyloss in the right eye for 3 months. On presentation, vision was 4/200 in the right and 20/20 in the left with an afferent pupillary defect on the right. His visual field was full to confrontation but automated perimetry revealed a central scotoma. The remainder of the exam was normal with the except...
157 Joe & Jerry Flew the CoopLulu LCD Bursztyn, MD, Ivey Eye Institute; Dane A. Breker, MD, Sanford Neuroscience Clinic; Andrew W. Stacey, MD, University of Washington Medicine; Ashok Srinivasan, MBBS, University of Michigan; Mark W. Johnson, MD, Kellogg Eye Center; Jonathan Daniel Trobe MD, Michigan UniversityA previously healthy 13-year-old girl presented to a local hospital with fever and myalgia, followed one day later by lethargy and vision loss. Past medical history was significant only for acne, for which she had been treated with doxycycline 40 mg/day intermittently starting 2 months prior to symp...
158 Requiem for a Cabinet MakerJennifer I. Doyle; Michael S. Vaphiades, MD, University of Alabama; James R. Hackney; Lanning B. Kline; Lina NagiaA 54-year-old white male presents with 3 weeks of painless horizontal nystagmus and 6 months of left sided forehead numbness. He reports a 20 lbs weight loss. Medical history includes a renal transplant 30 years prior. He takes prednisone 30 mg QOD and azathioprine. Visual acuity is 20/20 OU, color ...
159 A Weak PresentationReuben M. Valenzuela; Bradley J. Katz; Alison V. Crum; Kathleen B. Digre; Nick Mamalis; Hans C. Davidson; Judith E.A. Warner, MD, Moran Eye Center, University of UtahAn 82-year-old right-handed man with myasthenia gravis presented in May 2014 with double vision and right facial numbness and weakness. He was first seen in 1998 with horizontal diplopia. He had an abduction deficit of the right eye, and right nasolabial fold flattening. He was diagnosed with myasth...
160 Star Spangled BannerDara M. Bier; Jeffrey P. Greenfield; Marc K. Rosenblum; Joseph P. Comunale Jr; Cristiano Oliveira; Marc J. DinkinA 12-year-old girl with a history of bilateral optic nerve enlargement, enterovirus meningitis, seizures, and bilateral hygromas, presented with acute onset chronic vision loss in her left eye. Two years prior, she presented to an outside hospital with headaches, intermittent speech arrest and right...
161 The Man with No Face (About Face)Michael S. Vaphiades, MD, University of Alabama; Jennifer I. Doyle, MD, Little Rock Eye Clinic; Lina Nagia, MD, Michigan State University; Kevin J. Bray, MD, Providence Health; Lanning B. Kline, MD, University of Alabama; Glenn H. Roberson, MD, University of Alabama; Adam E. Quinn, MD, Baptist Healt...A 61-year-old man presented with one week history of decreased vision OS. Past medical history includes asthma and amblyopia OD, but with complete visual loss OD 18 years prior. He takes no medications. He is retired but worked for 21 years in social science research. The remarkable thing upon meeti...
162 The Relationship Between PDE-5 Inhibitors and NAIONHoward D. Pomeranz, MDSildenafil was first synthesized by pharmaceutical chemists working at Pfizer. It was initially studied for use in hypertension and angina. Phase I clinical trials suggested that the drug had little effect on angina but could induce penile erection. Sildenafil (Viagra®) was patented in 1996 and app...
163 When a WEINO Goes Blind - VideoRustum Karanjia, Chiara La Morgia, Christina Liang, Carolyn Sue, Valerio Carelli, Peter A Quiros, Alfredo A. Sadun, MD, PhD, Flora L. Thornton Chair, Professor of Ophthalmology and Neurological Surgery, Keck School of Medicine at USCA 16 year old male presented to an outside center with binocular horizontal diplopia. His symptoms began approximately six months prior when he noticed difficulty reading. He was seen by an optometrist and prescribed reading glasses. His vision was 20/66 in the right eye and 20/25 in the left eye. H...
164 Not a Meatball - VideoSteven A. Newman, M.D., University of Virginia School of Medicine, James Mandell, Colleen Druzgal, John Jane Jr., Spencer Payne, Sugoto Mukherjee, Beatriz LopesIn April 2015, a 10 year old girl was referred for a four day history of ptosis and double vision. On examination, visual acuity was 20/20-OU; near vision was 3pt OU. Visual fields showed subtle arcuate visual field changes. External examination revealed palpebral fissures of 6.5 and 9 with an upper...
165 Masquerade - VideoAmanda D. Henderson; Jacques J. Morcos; Oliver G. Fischer; Joshua PasolA 68 year-old man from Nicaragua, with a past medical history of diabetes and hypertension, presented with a one-year history of right-sided headaches, diplopia, and a four-month history of sudden vision loss in his right eye. In Nicaragua, a head CT and an angiogram had revealed a sphenoid wing and...
166 Heart of Darkness - VideoShira Simon, Shiraaz I. Rahman, John C. Heymann, Bahram Rahmani, Nicholas J Volpe, MD, Northwestern UniversityAn 18 year-old woman presented to the emergency department in October 2014 with three days of blurred vision in her left eye. Past medical history included a hypoplastic right heart status-post orthotopic heart transplant at 2 months of age, chronic kidney disease with BK viremia since 12 years of a...
167 "Not Right in the Head" - VideoMelinda Y. Chang, MD; Janet Lee, MD; Robert A. Goldberg, MD; Stacy L. Pineles, MDA 55 year old man presented with eight months of progressive left orbital swelling. His past ocular history was significant for LASIK of the right eye with monovision. His past medical history was significant for melanoma of the left arm, treated by surgical excision, with two negative lymph nodes, ...
168 It Is, Is It Not? - VideoIvana Vodopivec, Derek H. Oakley, Nagagopal Venna, John H. Stone, E. Tessa Hedley-Whyte, Sashank Prasad, MD, Brigham and Women's HospitalA 44-year-old man presented with visual loss, confusion, apraxia, and left-sided weakness. His medical history included retinal vasculopathy, chronic kidney disease, hypertension, and hypertensive cardiomyopathy that had presented over the preceding six years. The retinal vasculopathy had been terme...
169 Avengers Assemble! - VideoRadha Ram, Carrie A. Mohila, Jeremy Y. Jones, Veeral S. ShahA five-year-old otherwise healthy boy presented with a two-week history of behavioral changes, nausea, vomiting, headache, and subacute vision loss bilaterally. Six weeks prior to presentation to our hospital, he had presented to an outside hospital with esotropia and blurred vision in both eyes. At...
170 Leopard Can't Change Its Spots - VideoTerry S. Kang, Veeral S. ShahAn 8 year-old Caucasian female presented with bilateral conjunctivitis, photophobia, and blurred vision. Visual acuity was 20/50 OD and 20/60 OS. She had 2-3+ anterior chamber cell and flare OU, 1+ vitreous cells OU, 2+ optic disc edema OU, and macular edema OU. She was diagnosed with anterior uveit...
171 Is It or Isn't It? - VideoPeter W. MacIntosh, Scott Jones, Milena Stocic, Amy Lin, Heather MossA 58-year-old woman with recurrent left idiopathic orbital inflammation (IOI) presented with one day of rapidly progressive bilateral proptosis, edema, right eye redness, photophobia, and blurry vision. Her right eye had previously been asymptomatic. Her left eye had macular scarring with reduced vi...
172 Eyes and Bowels Bottled Up - VideoKristopher Kowal, Jonathan Daniel Trobe MD, Michigan University, Theodore T. BrownA 56 year-old man presented with diplopia and ptosis. Actually he was more concerned about severe constipation that had started about the same time. Abdominal x-rays had shown stool loading; laxatives had been ineffective. Our exam showed bilateral ptosis with complete ophthalmoplegia in both eyes. ...
173 A Night at the Met - VideoClotilde Hainline, Janet C. Rucker, David Zagzag, Yvonne W. Liu, Floyd A. Warren, Laura J. Balcer, MD, Professor, Department of Neurology, NYU Langone; Steven L. Galetta, MD, NYU LangoneA 73-year old woman with no headache history presented to the emergency department with several days of right-sided, retro-ocular, and vertex headaches and inability to see the left side of the TV screen-- all beginning 1 week after cataract surgery. Evaluation by her ophthalmologist was unrevealing...
174 Growing Up Too Fast - VideoCourtney E. Francis, Thomas T. Chia, Gordana Juric-Sekhar, Manuel FerreiraA 7 ½ year old boy presented in 2000 with precocious puberty (development of pubic hair, acne and rapid linear growth). Work-up included a brain MRI revealing a suprasellar mass, consistent with a visual pathway glioma. On ophthalmologic evaluation, he was noted to be 20/25 OU with a normal fundusc...
175 In the Thick of ItKannan M. Narayana; Ritesh A. Ramdhani; Bradford Tannen; Laura J. Balcer; Steven L. Galetta; Janet C. RuckerA 38 year-old woman with a history of premature birth with significant developmental delay was sent for neuroophthalmic evaluation for excessive head movements with gaze shifting. As an adult, she was verbal and able to take the bus alone to a day program. Over the past two years, language and cogni...
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