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1 167-8Third Nerve Palsy; Aberrant ReinnervationThe patient is a 48 year old man from Saudi Arabia who came to the Massachusetts General Hospital for a second opinion and hopefully for surgical correction of ptosis of the left eye (OS). He had a long standing left third nerve palsy due to compression of the nerve trunk by a cavernous sinus mening...Ptosis; Unilateral Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Pupil Dilated and Fixed; Oculomotor Nerve; Cavernous Sinus Meningioma; Cavernous Sinus Syndrome; Aberrant Reinnervation
2 942-5Alexia 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
3 168-3Apraxia Eyelid OpeningThis patient first presented to his PCP with increasing immobility. A diagnosis of Parkinson's disease was made. When his condition progressed, he was referred to the Neurology Clinic. Neuro-ophthalmological examination showed: Apraxia of eyelid opening Impaired initiation of horizontal saccades ...Apraxia of Eyelid Opening; Impaired Initiation of Horizontal Saccades; Slow Hypometric Horizontal Saccades; Supranuclear Paralysis of Up and Downgaze Degeneration; Progressive Supranuclear Palsy - Tauopathy; Steele Richardson Olszewski Syndrome; CNS - Degeneration
4 932-3Apraxia of Eyelid OpeningIn January 1997, This 73 year old patient was referred to the Neurovisual Clinic. At that time his speech was slurred and he stated that his eyes were his "biggest" complaint due to: 1. Impaired focusing "close up" 2. His eyes shut spontaneously much of the time 3. Bright sunlight provoked eye ...Apraxia of Eyelid Opening; Impaired Initiation of Horizontal Saccades; Slow Hypometric Horizontal Saccades; Supranuclear Paralysis of Up and Downgaze Degeneration; Square wave Jerks; Progressive Supranuclear Palsy - Tauopthay; Steele Richardson Olszewski Syndrome; CNS - Degeneration
5 907-1Ataxic GaitThe patient is a 72 year old woman who presented with a 4 year history of progressive difficulty with balance, frequent falls and unsteadiness walking. She required a cane to steady herself. Past History: Significant for alcohol abuse. In 1980, she came to Boston for a second opinion and was seen...Square Wave Jerks; Dysmetria; Horizontal Saccadic Hypermetria; Horizontal Gaze Evoked Nystagmus; Saccadic Pursuit; Gait Ataxia; Alcoholic Cerebellar Degeneration; Gaze Evoked Horizontal Nystagmus; Horizontal Saccadic Dysmetria; Alcohol
6 161-5Benign Essential BlepharospasmPatient is a 55 year old woman functionally blind from severe benign essential blepharospasm. She presented with frequent blinking.continuous spasms of eye closure and great difficulty opening her eyes i.e. blepharospasm associated "apraxia of eyelid opening". Symptomatic Inquiry negative for...Benign Essential Blepharospasm; Focal Dystonia; Blepharospasm
7 946-4Benign Essential BlepharospasmThe patient is a 60 year old estate manager with a history of retinal laser therapy, dry eyes and age related bilateral ptosis. He carries a diagnosis of hilar lymphadenopathy due to sarcoid and has had cancer of the kidney. He presented in 1995 with a 6 month history of frequent blinking and sp...Benign Essential Blepharospasm; Focal Dystonia
8 936-1Benign Neonatal Ocular FlutterShortly after birth, this baby was noted to have "jiggling eyes" by his mother. He was in good general health and neurologically intact. Cogan and I saw the baby and Cogan made the diagnosis of neonatal ocular flutter. In 1954 Cogan first used the term "ocular flutter" to describe a rare disorder o...Benign Neonatal Ocular Flutter
9 163-6Bilateral Internuclear OphthalmoplegiaThis case was reported by Cogan DG and Wray SH. Internuclear ophthalmoplegia as an early sign of brain tumor. Neurology 1970; 20:629-633. The patient is Case 1. He is a 4 ½ year old boy whose parents noted that the right eye had been "drifting" for four months. On examination the only signific...Bilateral Internuclear Ophthalmoplegia; Upbeat Nystagmus; Medulloblastoma; Abducting Nystagmus
10 933-1Bilateral Internuclear OphthalmoplegiaThe patient is a 25 year old woman who was in excellent health until 4 days prior to admission when she noted blurred vision and horizontal double vision on lateral gaze to right and left. Past History: Negative for strabismus as a child. No previous episodes of transient neurological symptoms. Fa...Bilateral Internuclear Ophthalmoplegia; Abducting Nystagmus; Normal Convergence; Gaze Evoked Upbeat Nystagmus; Gaze Evoked Downbeat Nystagmus; Saccadic Dysmetria; Multiple Sclerosis; Horizontal Saccadic Dysmetria
11 941-2Bilateral 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
12 163-155Bilateral Internuclear Ophthalmoplegia (INO)The patient is a 48 year old woman who presented with horizontal double vision looking to the right and to the left. She also noted blurring of vision with the image jerking horizontally back and forth. Neuro-ophthalmological examination: Visual acuity 20/20 OU corrected Visual fields, pupils, and f...Bilateral Internuclear Ophthalmoplegia; Abducting Nystagmus; Upbeat Nystagmus on Upgaze; Oscillopsia; Multiple Sclerosis
13 210-1Bilateral PtosisThis case, previously reported in 2007, is published courtesy of John Newsom-Davis, M.D., FRCP, FRS, CBE. Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford. This patient was unusual in presenting in early childhood and the development of persistent facial muscle and tongue...Bilateral Ptosis; Full Eye Movements; Facial Weakness; Tongue Atrophy; MuSK Antibody Myasthenia Gravis
14 163-10Bilateral PtosisThe patient is a 65 year old physician who presented with intermittent drooping of his eyelids, particularly at the end of the day. He found that if he gently closed his eyes when he came to a stop in his car at a set of traffic lights, his eyelids opened more fully. He subsequently developed inte...Bilateral Ptosis; Decompensated Phoria; Myasthenic Lid Twitch; Tensilon Test; Bilateral Myasthenia Gravis; Ocular Myasthenia Gravis; Ptosis -- Myasthenic
15 919-2Bilateral PtosisPatient is a 65 year old woman who presented with acute onset of bilateral ptosis. She awoke one day and found her eyelids half shut and she was unable to see. The lids completely shut and she came to the Massachusetts General Hospital Emergency Room and was admitted. Past History: Negative for pt...Nuclear Third Nerve Palsy; Bilateral Ptosis; Central Caudal Nucleus; Midbrain Ptosis; Oculomotor Nerve; Thalamic Infarct
16 925-2Bilateral Ptosis Facial DiplegiaThe patient is a 74 year old woman who one month prior to admission suffered from a non-productive cough, right ear pain, and pharyngitis treated with amoxicillin. On the day prior to admission she awoke with blurred vision and horizontal and vertical diplopia that persisted all day. The next m...Bilateral Ptosis; Total External Ophthalmoplegia; Normal Pupils; Facial Diplegia; Areflexia; Acute Inflammatory Demyelinating Neuropathy; Guillian Barre Syndrome - Miller Fisher Syndrome
17 944-1Bilateral 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
18 165-2Bilateral Sixth Nerve PalsyThe patient is a 60 year old woman who consulted her ophthalmologist with a chief complaint of double vision looking to the left. He diagnosed of a left sixth nerve palsy. No investigations were done. Two years later she complained of diplopia looking to the right. A diagnosis of bilateral six...Esotropia; Bilateral Abduction Weakness; Bilateral Sixth Nerve Palsy; Clivus Meningioma; Sixth (Abducens)
19 944-5Bilateral 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
20 169-34Bilateral Sixth Nerve PalsyThis patient has CNS B-cell lymphoma involving the dura mater. She presented with a chief complaint of "double vision and a squint is his right eye". On examination she was found to have bilateral sixth nerve palsy and paralytic esotropia. Comment: Lymphoma involving the dura is uncommon. Most p...Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS B-Cell Lymphoma
21 163-3Bilateral Sixth Nerve PalsyThis patient was known to be a chronic alcoholic. He presented with acute onset of unsteadiness walking which he attributed to double vision. He was unable to give an accurate history and was disoriented for time and place. Neurological examination: Significant for impaired memory and cognitive ...Bilateral Sixth Nerve Palsy; Esotropia; Supranuclear Paralysis of Downgaze; Absent Convergence; Upbeat Nystagmus on Upgaze; Wernicke's Disease; Supranuclear Paralysis of Downgaze Encephalopathy; Gaze Evoked Upbeat Nystagmus; Wernicke Encephalopathy; Thiamine Deficiency
22 946-2Bilateral Sixth Nerve PalsyThe patient is a 70 year old Italian man with atrial fibrillation on long-term coumadin therapy. In October 1995, he developed generalized headache, horizontal double vision and his left eye deviated inwards (esotropia). A diagnosis of left sixth nerve palsy was made and attributed to microvascular ...Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS Non-Hodgkin's Lymphoma; Cavernous Sinus Syndrome; Lymphoma
23 939-8Bilateral 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
24 162-7Congenital Horizontal Gaze PalsyThe patient is an 8 year old boy with a rare autosomal recessive disorder characterized by congenital absence of conjugate horizontal eye movements preservation of vertical gaze and convergence and progressive scoliosis (HGPPS) developing in childhood. The child was referred to Dr. Cogan with a ...Congenital Horizontal Gaze Palsy; Progressive Scoliosis; Mutation of the ROBO 3 Gene on Chromosome 11q23-q25; Congenital Cranial Disinnervation Syndrome; Mobius Syndrome
25 163-9-1Congenital NystagmusThis young boy has oculocutaneous albinism. In 1979 he presented for evaluation of oscillations of his eyes present since birth. He had no head turn or head tremor. Diagnosis: Albinism Congenital sensory nystagmus Ocular Albinism: Infants with albinism of all types are typically slow to see, ofte...Congenital Nystagmus; Horizontal Pendular Nystagmus; Optokinetic Nystagmus Absent; Infantile Nystagmus Syndrome; Oculocutaneous Albinism
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