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201 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 48-year-old female was seen in May 1996 with a history of 2 months of diplopia from a right abducens palsy. This was due to the recurrence of myeloma that had initially been diagnosed and treated with radiation and chemotherapy 9 years before and required further therapy, including bone marrow ...
202 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 48-year-old female was seen in May 1996 with a history of 2 months of diplopia from a right abducens palsy. This was due to the recurrence of myeloma that had initially been diagnosed and treated with radiation and chemotherapy 9 years before and required further therapy, including bone marrow ...
203 Neuro-Ophthalmic Vascular DiseaseJacqueline A. Leavitt, MDArteriovenous malformations are dysplastic vascular channels. They may result in neuro-ophthalmologic findings from direct compressive effects, secondary hemorrhage, or secondary seizure disorder. CT and/or MRI may demonstrate the lesion, but cerebral arteriography is usually required to better defi...
204 Isolated Optic Neuritis/NeuropathyLarry P. Frohman, MDThe patient is a 62-year-old female who presented in August 1996 with visual loss OD that she first noted as loss of her superior field in May 1996. She felt that it had been static since, and perhaps was even a little better in the week before she was seen. There was no pain, even with ocular rotat...
205 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 74-year-old asthmatic male had acute visual loss OS while watching the Super Bowl in 1994. He was seen the next day by a retina specialist, who noted that his optic disc was normal and referred the patient to a neuro-ophthalmologist, who evaluated him about 40 hours after his visual loss. He wa...
206 Neuro-Ophthalmic Vascular DiseaseLarry P. Frohman, MDThis 23-year-old woman has had insulin-dependent diabetes mellitus since age 3. She was diagnosed with Sydenham's chorea in early childhood and had grand mal seizures from age 13 to 15. She has been hypertensive since age 18. Her vision was 20/25 OD and 20/40 OS, with dyschromatopsia OS, and a 1.8 l...
207 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 74-year-old asthmatic male had acute visual loss OS while watching the Super Bowl in 1994. He was seen the next day by a retina specialist, who noted that his optic disc was normal and referred the patient to a neuro-ophthalmologist, who evaluated him about 40 hours after his visual loss. He wa...
208 Systemic Disorders With Optic Nerve and Retinal FindingsLarry P. Frohman, MDThis 74-year-old asthmatic male had acute visual loss OS while watching the Super Bowl in 1994. He was seen the next day by a retina specialist, who noted that his optic disc was normal and referred the patient to a neuro-ophthalmologist, who evaluated him about 40 hours after his visual loss. He wa...
209 Isolated Hereditary Optic Neuritis/NeuropathyGregory S. Kosmorsky, MDLeber's hereditary optic neuropathy is a mitochondrial hereditary optic neuropathy that usually affects young males but may occur at any age and in males or females. The clinical features are usually acute bilateral simultaneous or sequential visual loss with a central acuity and central visual fiel...
210 Isolated Hereditary Optic Neuritis/NeuropathyGregory S. Kosmorsky, MDLeber's hereditary optic neuropathy is a mitochondrial hereditary optic neuropathy that usually affects young males but may occur at any age and in males or females. The clinical features are usually acute bilateral simultaneous or sequential visual loss with a central acuity and central visual fiel...
211 Isolated Hereditary Optic Neuritis/NeuropathyGregory S. Kosmorsky, MDLeber's hereditary optic neuropathy is a mitochondrial hereditary optic neuropathy that usually affects young males but may occur at any age and in males or females. The clinical features are usually acute bilateral simultaneous or sequential visual loss with a central acuity and central visual fiel...
212 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 ...
213 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.
214 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.
215 Optic NeuropathiesLarry P. Frohman, MDThe patient is a 66-year-old man with a history of ethanol abuse. He presented with 3 months of right-sided headache and a few days of progressive visual loss OD to hand motions only. When seen by the orbital service, he had nearly complete ophthalmoplegia and ptosis. Sinus biopsy showed fungus, whi...
216 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...
217 Isolated Congenital Optic Disc AnomaliesThomas R. Wolf, MDOptociliary shunt vessels are venous collaterals that form in response to chronic venous obstruction, shunting the venous blood from the retinal circulation into the choroidal circulation. Although they may be congenital, they may occur in patients with chronic disc edema, following central retinal ...
218 Ocular Manifestations of Systemic DisordersLarry P. Frohman, MDThe same young woman from Case 77 (Image 92_57) presented 8 years after the orbital biopsy with this retinal lesion, presumably from her underlying disorder. The eye has 20/20 vision and no other disturbances. This is a fundus photo.
219 Neuro-Ophthalmic Vascular DiseaseAnthony C. Arnold, MDThis 76-year-old woman has a 7-month history of redness and pressure sensation in both eyes that is worse in the morning. She has noted intermittent horizontal diplopia during this time. Angiography demonstrated a right dural cavernous sinus fistula, which was successfully occluded with direct injec...
220 Neuro-Ophthalmic Vascular DiseaseAnthony C. Arnold, MDThis 76-year-old woman has a 7-month history of redness and pressure sensation in both eyes that is worse in the morning. She has noted intermittent horizontal diplopia during this time. Angiography demonstrated a right dural cavernous sinus fistula, which was successfully occluded with direct injec...
221 Neuro-Ophthalmic Vascular DiseaseAnthony C. Arnold, MDThis 76-year-old woman has a 7-month history of redness and pressure sensation in both eyes that is worse in the morning. She has noted intermittent horizontal diplopia during this time. Angiography demonstrated a right dural cavernous sinus fistula, which was successfully occluded with direct injec...
222 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.
223 Congenitally Tilted Optic DiscAnthony C. Arnold, MDColobomas or defects of the optic nerve may exhibit spontaneous pulsations. Disease/Diagnosis: Coloboma.
224 Neuro-Ophthalmic Imaging-CT ScanLarry P. Frohman, MDThis 39-year-old woman's initial sign was painless, progressive, symmetric ptosis OU, without diurnal variation, that manifested when she was age 17 living in the Dominican Republic. At that time, she had no diplopia or systemic signs. She had no family history of ocular or muscle disease, and no ot...
225 Isolated Optic Neuritis/NeuropathyLarry P. Frohman, MDThe patient is a 62-year-old female who presented in August 1996 with visual loss OD that she first noted as loss of her superior field in May 1996. She felt that it had been static since, and perhaps was even a little better in the week before she was seen. There was no pain, even with ocular rotat...
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