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Browsing items in: EHSL - Shirley H. Wray Neuro-Ophthalmology Collection

(161 results)



Display: 100

    • Alexia Without Agraphia

    • 942-5
    • The 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...
    • 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
    • Apraxia Eyelid Opening

    • 168-3
    • This 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...
    • 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;...
    • Apraxia of Eyelid Opening

    • 932-3
    • In 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...
    • 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...
    • Ataxic Gait

    • 907-1
    • The 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...
    • 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;
    • Benign Essential Blepharospasm

    • 161-5
    • Patient 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...
    • Benign Essential Blepharospasm; Focal Dystonia; Blepharospasm
    • Benign Essential Blepharospasm

    • 946-4
    • The 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...
    • Benign Essential Blepharospasm; Focal Dystonia;
    • Benign Neonatal Ocular Flutter

    • 936-1
    • Shortly 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...
    • Benign Neonatal Ocular Flutter
    • Bilateral Internuclear Ophthalmoplegia

    • 941-2
    • This 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...
    • Bilateral Internuclear Ophthalmoplegia; Pendular Horizontal Oscillations; Lid Nystagmus; Upbeat Nystagmus; Botulinum Toxin Therapy; Multiple Sclerosis; Horizontal Pendular Nystagmus; Gaze Evoked Upbeat Nystagmus; Abducting Nystagmus;
    • Bilateral Internuclear Ophthalmoplegia

    • 163-6
    • This 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...
    • Bilateral Internuclear Ophthalmoplegia; Upbeat Nystagmus; Medulloblastoma; Abducting Nystagmus;
    • Bilateral Internuclear Ophthalmoplegia

    • 933-1
    • The 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...
    • Bilateral Internuclear Ophthalmoplegia; Abducting Nystagmus; Normal Convergence; Gaze Evoked Upbeat Nystagmus; Gaze Evoked Downbeat Nystagmus; Saccadic Dysmetria; Multiple Sclerosis; Horizontal Saccadic Dysmetria;
    • Bilateral Internuclear Ophthalmoplegia (INO)

    • 163-155
    • 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...
    • Bilateral Internuclear Ophthalmoplegia; Abducting Nystagmus; Upbeat Nystagmus on Upgaze; Oscillopsia; Multiple Sclerosis;
    • Bilateral Ptosis

    • 163-10
    • The 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...
    • Bilateral Ptosis; Decompensated Phoria; Myasthenic Lid Twitch; Tensilon Test; Bilateral Myasthenia Gravis; Ocular Myasthenia Gravis; Ptosis -- Myasthenic
    • Bilateral Ptosis

    • 919-2
    • Patient 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...
    • Nuclear Third Nerve Palsy; Bilateral Ptosis; Central Caudal Nucleus; Midbrain Ptosis; Oculomotor Nerve; Thalamic Infarct
    • Bilateral Ptosis

    • 210-1
    • This 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...
    • Bilateral Ptosis; Full Eye Movements; Facial Weakness; Tongue Atrophy; MuSK Antibody Myasthenia Gravis;
    • Bilateral Ptosis Facial Diplegia

    • 925-2
    • The 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...
    • Bilateral Ptosis; Total External Ophthalmoplegia; Normal Pupils; Facial Diplegia; Areflexia; Acute Inflammatory Demyelinating Neuropathy; Guillian Barre Syndrome – Miller Fisher Syndrome
    • Bilateral Ptosis Facial Diplegia

    • 944-1
    • The 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,...
    • Bilateral Ptosis; Total External Ophthalmoplegia; Facial Diplegia; Areflexia; Acute Inflammatory Demyelinating Neuropathy;Guillian Barre Syndrome – Miller Fisher Syndrome; Facial Weakness
    • Bilateral Sixth Nerve Palsy

    • 946-2
    • The 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...
    • Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS Non-Hodgkin’s Lymphoma; Cavernous Sinus Syndrome; Lymphoma;
    • Bilateral Sixth Nerve Palsy

    • 163-3
    • This 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...
    • 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...
    • Bilateral Sixth Nerve Palsy

    • 169-34
    • This 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...
    • Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS B-Cell Lymphoma;
    • Bilateral Sixth Nerve Palsy

    • 165-2
    • The 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...
    • Esotropia; Bilateral Abduction Weakness; Bilateral Sixth Nerve Palsy; Clivus Meningioma; Sixth (Abducens)
    • Bilateral Sixth Nerve Palsy

    • 944-5
    • The 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...
    • Voluntary Ptosis; Bilateral Sixth Nerve Palsy; Esotropia; Paresis of Conjugate Upgaze; Acute Inflammatory Demyelinating Neuropathy; Guillian Barre Syndrome – Miller Fisher Syndrome;
    • Bilateral Sixth Nerve Palsy

    • 939-8
    • This 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...
    • Bilateral Sixth Nerve Palsy; Bilateral Esotropia; Paraneoplastic Opsoclonus/Flutter; Paraneoplastic Cerebellar Syndrome; Carcinoma of the Breast; Paraneoplastic Opsoclonus;
    • Congenital Horizontal Gaze Palsy

    • 162-7
    • The 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...
    • Congenital Horizontal Gaze Palsy; Progressive Scoliosis; Mutation of the ROBO 3 Gene on Chromosome 11q23-q25; Congenital Cranial Disinnervation Syndrome; Mobius Syndrome
    • Congenital Nystagmus

    • 938-4
    • This 34 year old physician has had a life long problem with congenital nystagmus. He was an orphan and his adopted parents took him to see a pediatrician when he was very small. A missed diagnosis of a “lazy eye” was made. Subsequently, at...
    • Congenital Nystagmus; Horizontal Jerk Nystagmus; Optokinetic Nystagmus Absent; Infantile Nystagmus Syndrome; Oscillopsia;
    • Congenital Nystagmus

    • 163-9-1
    • This 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...
    • Congenital Nystagmus; Horizontal Pendular Nystagmus; Optokinetic Nystagmus Absent; Infantile Nystagmus Syndrome; Oculocutaneous Albinism;
    • Congenital Nystagmus

    • 163-9-3
    • This child has had nystagmus since childhood with a head turn to the left. He was seen by his pediatrician. Diagnosis: Horizontal jerk nystagmus (congenital motor nystagmus) Congenital nystagmus Classification: The Classification of Eye Movement...
    • Congenital Nystagmus; Horizontal Jerk Nystagmus; Optokinetic Nystagmus Absent; Infantile Nystagmus Syndrome;
    • Congenital Nystagmus

    • 169-23
    • This child was noted to have oscillations of the eyes in infancy and was given a diagnosis of congenital nystagmus.
    • Congenital Nystagmus; Horizontal Pendular Nystagmus; Infantile Nystagmus Syndrome; Optokinetic Nystagmus Absent; Fusional Maldevelopment Nystagmus Syndrome; Horizontal Jerk Nystagmus; Congenital vs Acquired Nystagmus; Congenital Motor Nystagmus;
    • Congenital Nystagmus

    • 944-8
    • This 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...
    • Congenital Nystagmus; Horizontal Jerk Nystagmus; Optokinetic Nystagmus Absent; Infantile Nystagmus Syndrome; Oscillopsia; Cleidocranial Dysostosis;
    • Congenital Nystagmus

    • 936-6
    • This 11 year old Italian boy was referred for evaluation of nystagmus. Emanuel is the second son in a family of two and his older brother, age 13, had no visual problem. Emanuel was born at term, normal delivery, birth weight 9 pounds. ...
    • Congenital Nystagmus; Infantile Nystagmus Syndrome; Horizontal Pendular Nystagmus; Optokinetic Nystagmus Absent; Hypoplasia of the Macula;
    • Congenital Nystagmus - Latent Nystagmus

    • 907-2
    • This boy was not recognized to have nystagmus until he accidentally discovered that he had blurred vision in one eye while pulling a sweater off over his head and blocking the vision of one eye. An ophthalmologist saw him and diagnosed latent...
    • Latent Nystagmus; Fusional Maldevelopment Nystagmus Syndrome;
    • Congenital Nystagmus; Latent Nystagmus

    • 163-9-2
    • This little girl has had nystagmus since birth. She has the classical constellation of signs, initially diagnosed as congenital motor nystagmus with: • Horizontal jerk nystagmus • A slight head turn to the right to place the eyes in the null...
    • Congenital Nystagmus; Horizontal Jerk Nystagmus; Optokinetic Nystagmus absent; Infantile Nystagmus Syndrome Latent Nystagmus; Fusional Maldevelopment Nystagmus Syndrome;
    • Congenital Ocular Motor Apraxia

    • 162-2
    • This little boy was born at term after a normal pregnancy. There was no family history of a neurological or ophthalmological disease. His mother noted from birth that he turned his head instead of his eyes and frequently tried to fix objects...
    • Congenital Ocular Motor Apraxia; Head Thrust;
    • Congenital Ocular Motor Apraxia

    • 162-3
    • This baby was born at term after an uneventful pregnancy and normal delivery. He was the first and only child. There was no family history of any This baby was born at term after an uneventful pregnancy and normal delivery. He was the first and...
    • Congenital Ocular motor apraxia; Head Thrust;
    • Congenital Ocular Motor Apraxia

    • 162-5
    • This 3 year old boy was referred for evaluation of inattention. He was born at term after a normal pregnancy. He had been noted, in early childhood, to have difficulty looking to the right and to the left and was slow to read.
    • Congenital Ocular Motor Apraxia; Head Thrust;
    • Convergence Insufficiency

    • 942-2
    • The 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...
    • Blepharoclonus; Convergence Insufficiency; Slow Hypometric Horizontal Saccades; Saccadic Breakdown of Smooth Pursuit; Parkinson's Disease- Dopamine deficiency;
    • Convergence Insufficiency

    • 931-4
    • The patient is a 73 year old man with a ten year history of idiopathic Parkinson's disease characterized by difficulty in walking, generalized rigidity and a mild tremor of his hands at rest with deterioration in his handwriting. He denied any...
    • Basal Ganglia; Blepharoclonus; Convergence Insufficiency; Slow Hypometric Saccades; Saccadic Breakdown of Smooth Pursuit; Parkinson's Disease- Dopamine deficiency; Slow Hypometric Horizontal Saccades; Convergence;
    • Downbeat Nystagmus

    • 003-3
    • This patient carries a diagnosis of Type I Chiari malformation. Neurological symptoms of a Chiari malformation may not develop until adolescence or adult life as in this man. The symptoms may be those of: 1. Increased intracranial pressure,...
    • Downbeat Nystagmus; Lid Nystagmus; Oscillopsia; Chiari-1 Malformation; Primary Position Downbeat Nystagmus; Chiari Malformation
    • Downbeat Nystagmus

    • 919-1
    • This patient carries a diagnosis of Type I Chiari malformation. In 1983 she presented with vertical double vision which persisted. Two months later, she had an acute episode of irritation of her eyes possibly due to allergy, followed two days...
    • Downbeat Nystagmus; Dysmetria; Oscillopsia; Chiari-1 Malformation; Primary Position Downbeat Nystagmus; Vertical Saccadic Dysmetria; Horizontal Saccadic Dysmetria;
    • Downbeat Nystagmus

    • 166-11
    • The patient is a 72 year old man who was found down and admitted as an emergency in coma. Neurological examination: Patient in coma failed to respond to painful stimuli. Downbeat nystagmus Lid nystagmus Pupils 2 mm OU responsive to...
    • Coma; Downbeat Nystagmus; Lid Nystagmus; Bilateral Horizontal Gaze Palsy; Pontine Hemorrhage; Bilateral Horizontal Gaze Palsy Hemorrhage; Primary Position Downbeat Nystagmus
    • Downbeat Nystagmus

    • 170-53
    • In 1984, this young woman was involved in a motor vehicle accident when her car was hit from behind. She struck her head on the dash board but had no loss of consciousness. She was able to get out of the car unaided and was immediately aware...
    • Downbeat Nystagmus; Oscillopsia; Chiari-1 Malformation; Primary Position Downbeat Nystagmus
    • Downbeat Nystagmus

    • 927-2
    • The patient is a 59 year old woman who carried a diagnosis of: 1. Congenital anomaly of the occipito-cervical junction with occipitalization of the C1 ring 2. Basilar invagination with Chiari Type I 3. A syrinx in the center of the...
    • Downbeat Nystagmus; Oscillopsia; Chiari-1 Malformation; Primary Position Downbeat Nystagmus; Vertical Saccadic Dysmetria; Horizontal Saccadic Dysmetria; Ataxia;
    • Downbeat Nystagmus

    • 922-5
    • This 58 year old engineer was referred by his neurologist for evaluation of periodic episodes of difficulty focusing and blurred vision for 8 years. In 1981 whilst sightseeing in Newport, he became acutely aware of difficulty focusing and blurry...
    • Downbeat Nystagmus; Oscillopsia; Primary Position Downbeat Nystagmus;
    • Dressing Apraxia

    • 946-5
    • The patient is a 72 year old right handed woman who presented in November 1995 with the sudden onset of impaired coordination of visual and motor skills following an inner right ear infection. One of her problems was difficulty sitting on a chair...
    • Dressing Apraxia; Apraxia of the Left Hand; Constructional Apraxia; Right Parietal Lobe; Progressive Lobar Atrophy; Degenerative CNS Disease; Apraxia
    • Duane's Syndrome

    • 923-5
    • The patient is a 7 year old boy born two weeks premature with transposition of the major arteries of the heart, four holes in the heart, and an absent spleen. He had cardiac surgery at age 2 days and at age one year and his development was...
    • Unilateral Duane’s Syndrome, Type 3; Fourth Nerve Palsy; Localization of a Gene on Chromosome 2q31; Congenital Cranial Disinnervation Syndrome; Sixth Nerve Palsy; Unilateral Sixth Nerve Palsy; Congenital Duane's Syndrome; Duane's Syndrome
    • Elliptical Nystagmus

    • 166-24
    • The patient carries a diagnosis of multiple sclerosis.
    • Primary Position Elliptical Nystagmus; Multiple Sclerosis;
    • Essential Palatal Tremor

    • 929-1
    • The patient is a 25 year old meteorologist from Tennessee who came to Boston in the summer of 1992 to vacation with his family on the Cape. His illness started with flu-like symptoms, low grade fever from 99 to 100F, sweating and episodes of light...
    • Essential Palatal Tremor (Myoclonus); Brainstem Encephalitis;
    • Eyebrow Spasm

    • 211-1
    • This case is published courtesy of Daniel J. Costello, M.D., Department of Neurology, Massachusetts General Hospital, Boston. The patient is a 32-year-old right-handed man with an established diagnosis of Tuberous Sclerosis Complex characterized...
    • Rhythmic Eyebrow Spasm; Torsional Nystagmus; Primary Position Left Beating Nystagmus; Epileptic Seizures; Tuberous Sclerosis Complex (TSC-2 DNA sequence variant); Bipolar Affective Disorder;
    • Familial Myasthenia Gravis

    • 164-10
    • In 1999 Dr. A. G. Engel published a monograph on Myasthenia Gravis and Myasthenic Disorders with a chapter devoted to Congenital Myasthenic Syndromes. Dr. Engel systematically defined and classified hereditary and congenital myasthenic...
    • Familial Myasthenia Gravis; External Ophthalmoplegia; Ocular Myasthenia Gravis; Unilateral Ptosis; Unilateral Myasthenia Gravis;
    • Familial Nystagmus

    • 163-9-4
    • The mother and her infant son both have conjugate horizontal pendular nysagmus. Diagnosis: Congenital sensory nystagmus Familial Infantile Nystagmus Syndrome (INS) The little boy is a bright active child with normal development. He has...
    • Congenital Nystagmus; Horizontal Pendular Nystagmus; Infantile Nystagmus Syndrome; Familial Congenital Nystagmus;
    • Fascicular Third Nerve Palsy

    • 166-26
    • The patient is a 76 year old woman who woke one morning unable to see out of her right eye because of ptosis. She came to the Massachusetts General Hospital emergency room and was admitted. Neurological Examination: Right third nerve palsy...
    • Ptosis; Fascicular Third Nerve Palsy; Fixed Dilated Pupil; Contralateral Limb Ataxia; Claude Syndrome; Midbrain Infarct; Oculomotor Nerve; Unilateral Third Nerve Palsy; Subnuclear; Fascicular Oculomotor (Third) Nerve Palsy; Third Nerve Dysfunction
    • Fisher's One and a Half Syndrome

    • 941-4
    • The 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...
    • 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;...
    • Fisher's One and a Half Syndrome

    • 166-14
    • This young man was seen in the emergency room of his local hospital following the onset of severe headache, mild confusion and diplopia. Non-contrast CT brain scan showed: A right pontine hemorrhage He was transferred to the Massachusetts...
    • Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Convergence Absent; Esotropia; Fisher's One-and-a-Half Syndrome; Facial Palsy; Abducens Nuclear Lesion; Pontine Hemorrhage; Unilateral Gaze Palsy Hemorrhage; Abducting...
    • Fisher's One and a Half Syndrome

    • 166-20
    • This 28 year old woman had severe multiple sclerosis with a spastic paraparesis due to a lesion of the spinal cord. She was admitted to the Intensive Care Unit complaining of dizziness and double vision. Neuro-ophthalmologic examination: Visual...
    • Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Fisher's One-and-a-Half Syndrome; Multiple Sclerosis; Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze...
    • Fisher's One and a Half Syndrome

    • 164-2
    • This young patient presented with double vision and was found to have on examination the classical findings of Fisher’s one-and-a-half syndrome which are: • Right internuclear ophthalmoplegia on gaze left with adduction weakness OD • Right...
    • Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Primary Position Upbeat Nystagmus; Convergence Normal; Fisher's One-and-a-Half Syndrome; Multiple Sclerosis; Unilateral Horizontal Gaze Palsy...
    • Fisher's One and a Half Syndrome

    • 941-6
    • The 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...
    • 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
    • Fisher's One and a Half Syndrome

    • 937-8
    • This 44 year old woman presented in 1973 with an acute attack of optic neuritis in the right eye that fully recovered after a course of ACTH therapy. In 1991, 18 years later, she developed unsteadiness of gait, “walking like a chicken”, stiff...
    • Unilateral Internuclear Ophthalmoplegia; Unilateral Horizontal Gaze Palsy; Upbeat Nystagmus on Upgaze; Convergence Normal; Fisher's One-and-a-Half Syndrome; Uhthoff’s Symptom; Multiple Sclerosis; Unilateral Horizontal Gaze Palsy Demyelination;...
    • Fourth Nerve Palsy

    • 929-2
    • The patient is a 64 year old engineer who noted whilst driving around Thanksgiving time double vision with one image on top of the other. Vertical double vision persisted and he was referred to the Massachusetts General Hospital for...
    • Hypertropia; Superior Oblique Paresis; Inferior Oblique Overaction; Fourth Nerve Palsy; Trochlear Nerve; Bielchowsky Test; Head Tilt;
    • Fourth Nerve Palsy

    • 940-1
    • The 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...
    • Hypertropia; Superior Oblique Paresis; Inferior Oblique Overaction; Fourth Nerve Palsy; Trochlear Nerve; Bielchowsky Test; Head Tilt; Fourth (Trochlear);
    • Gaucher's Disease

    • 918-1
    • This little boy has Gaucher’s disease. Gaucher’s disease is an autosomal recessive disorder, linked to chromosome 1q21, due to glucocerebroside β-glucosidase deficiency. There are three phenotypic variances of Gaucher’s disease. Type I...
    • Disorder of Horizontal Saccades; Impaired initiation; Slow velocity; Arcuate trajectory; Absent optokinetic nystagmus; Normal Vertical Gaze; Normal Pursuit; Juvenile Neuronopathic Gaucher’s Disease, Type 3; Autosomal recessive linked to...
    • Global Supranuclear Paralysis of Vertical Gaze

    • 207-1
    • This case was presented to the Clinical Eye Movement Society at the American Neurological Association Meeting in October 2007. The patient is a healthy, 36 year old Lieutenant Commander in the Coast Guard who was last seen perfectly well at 2 a.m....
    • Somnolence; Global Supranuclear Paralysis of Vertical Gaze; Absent Vertical Saccades and Pursuit Movements; Intact Convergence; Convergence Retraction Nystagmus; Ocular Dysmetria; Ocular Tilt Reaction; Lateropulsion; Unilateral Midbrain and...
    • Hemifacial Spasm

    • 161-19
    • This patient is an atypical case of hemifacial spasm because he is a young college student only 29 years of age. Hemifacial spasm usually develops in the fifth and sixth decade of life and affects women more than men. It often begins...
    • Lid Twitch; Hemifacial Spasm; Neurovascular Compression Syndrome of the Facial Nerve;
    • Hemifacial Spasm

    • 937-1
    • The patient is a 72 year old man with myopia, childhood exotropia, progressive age related ptosis and right hemifacial spasm. Hemifacial spasm (HS) most often begins insidiously in the orbicularis oculi muscle in the early stages, as in this...
    • Lid twitch; Hemifacial spasm; Neurovascular Compression Syndrome of the Facial Nerve;
    • Information Processing in the Visual System: David H. Hubel, Nobel Laureate Physiology or Medicine...

    • 948-1
    • David H. Hubel is the John Enders University Professor of Neurobiology at Harvard Medical School. Born in Canada of American parents, he grew up in Montreal, graduated from McGill Medical School, and received training in neurology at the Montreal...
    • Architecture of the Visual Cortex; Information Processing in the Visual System; David H. Hubel Nobel Laureate Physiology or Medicine 1981; AVP Association Areas
    • Jaw Winking

    • 161-1
    • This young boy was born at full term after a normal pregnancy with congenital unilateral ptosis of the left eyelid. His mother noticed that when he was sucking on a bottle the ptotic eyelid opened and closed. A diagnosis of the Marcus-Gunn jaw...
    • Congenital Unilateral Ptosis; Jaw Winking; Lid Winking; Trigemino-oculomotor Synkinesis; Marcus-Gunn Jaw Winking Phenomenon; Congenital Ptosis; Marcus Gunn Jaw Wink
    • Jaw Winking

    • 169-29
    • This little boy was born with congenital ptosis of the left eyelid, which "flicked up and down" when his jaw moved. The pediatrician made a diagnosis of the Marcus-Gunn jaw winking phenomenon was made. The first case of this unusual...
    • Congenital Unilateral Ptosis; Jaw Winking; Lid Winking; Trigemino-oculomotor Synkinesis; Marcus-Gunn Jaw Winking Phenomenon; Congenital Ptosis;
    • Latent Nystagmus

    • 169-28
    • This is one of the first cases of latent nystagmus that I saw with Dr. Cogan in the 1970’s. The presence of latent nystagmus was unknown to this patient, a little girl who was found to have latent nystagmus by the ophthalmologist at school...
    • Latent Nystagmus; Fusional Maldevelopment Nystagmus Syndrome;
    • Lateropulsion

    • 161-21
    • This 44 year old woman has a diagnosis of Multiple Sclerosis.
    •  
    • Lateropulsion

    • 209-1
    • This 60 year old patient has Wallenberg’s syndrome due to infarction of the left dorsolateral medulla. Wallenberg’s syndrome is the best recognized syndrome involving the vestibular nuclei and adjacent structures. Unilateral infarcts...
    • Deviation of the Eyes Under Closed Lids; Lateropulsion; Dorsolateral Medullary Infarction; Medulla Infarct;
    • Lid Lag

    • 004-3
    • The classical eye signs of thyroid associated ophthalmopathy (TAO) of Graves' Disease is illustrated by case ID925-4. This 50 year old woman with TAO is included in the collection because she illustrates very well lid lag (persistent elevation...
    • Lid Lag; Bilateral Exophthalmos; Restrictive Orbitopathy of Graves' Disease;
    • Migraine / PET Study

    • 041-1
    • In December 1994 the New England Journal of Medicine published a remarkable paper Bilateral Spreading Cerebral Hypoperfusion during Spontaneous Migraine Headache. Roger P. Woods, Marco Iacoboni and John C. Mazziotta. which is reproduced in part,...
    • Migraine Headache; Regional Cerebral Blood Flow; Migraine Visual Aura;
    • Migraine Visual Aura

    • 939-4
    • The 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...
    • Migraine Visual Aura; Occipital Lobe; Visual Phenomena;
    • Migraine Visual Aura

    • 932-5
    • The patient is a 9 year old right handed boy who developed headaches in 1993 at the age of 8. At that time he told his mother that he had bad headaches starting at the back of the head, usually bioccipital, spreading over the top of the head to...
    • Migraine Visual Aura without headache; Metamorphopsia; Macropsia - Hemi-macropsia; Alice in Wonderland Syndrome; Occipital Lobe; Visual Phenomena;
    • Migraine Visual Aura: A discussion with Nobel Laureate David H. Hubel

    • 947-2
    • I am greatly indebted to the Nobel Laureate, David Hubel for his permission to publish his description of his migraine aura. The recording was made fortuitously at the time that I invited David to the Unit for Neuro-Visual Disorders to record an...
    • Migraine Visual Aura; Occipital Lobe; Visual Phenomena; David H. Hubel, Nobel Laureate;
    • Migraine Visual Aura: A personal account

    • 947-1
    • I am greatly indebted to the Nobel Laureate, David Hubel for his permission to publish his description of his migraine aura. The recording was made fortuitously at the time that I invited David to the Unit for Neuro-Visual Disorders to record an...
    • Migraine Visual Aura; Occipital Lobe; Visual Phenomena;David H. Hubel, Nobel Laureate;
    • MS Time Lapse MRI

    • 040-1
    • Professor Ian McDonald, Institute of Neurology, Queen Square, London contributed this remarkable Time-Lapse MRI of focal MS lesions in a single patient with multiple sclerosis over a period of one year. This time lapse video was assembled from...
    • Multiple Sclerosis; Serial Brain MRI in Multiple Sclerosis
    • Neonatal Opsoclonus

    • 166-3
    • This child was one of the first cases of opsoclonus that I saw with Dr. Cogan in the early 1970’s. The baby is a unique case in that in addition to neonatal opsoclonus with the characteristic multidirectional conjugate back-to-back saccades,...
    • Neonatal Opsoclonus; Upbeat Nystagmus; Lid Nystagmus; Saccadic Oscillations;
    • Neonatal Opsoclonus

    • 166-4
    • This child was one of the first cases of opsoclonus that I saw with Dr. Cogan in the early 1970’s. He carried a diagnosis of strabismus with deviation of the left eye. In this child, opsoclonus occurred as a transient phenomenon in an otherwise...
    • Neonatal Opsoclonus; Lid Nystagmus; Saccadic Oscillations;
    • Normal Eye Movements

    • 910-2
    • The video of the normal eye movement examination was made with the assistance of Dr. Terrence Millette, a neurologist and former Fellow with me in 1985-1986. Introduction to the Saccadic System Saccades are fast eye movements that bring the...
    • Normal Eye Movements; Examination, Ocular; Saccades; Optokinetic nystagmus drum (OKN drum); Pursuit; Ocular Motility
    • Nuclear Third Nerve Palsy

    • 163-21
    • The following case is the first patient I saw with a nuclear third nerve palsy. The patient is a 52 year old man with hypertension and hyperlipidemia. He awoke one morning unable to open his eyes. To walk he tilted his head backwards and looked...
    • Nuclear Third Nerve Palsy; Bilateral Ptosis; Bilateral Superior Rectus Palsy; Normal Pupils; Midbrain Infarct; Oculomotor Nerve; Nuclear; Thalamic Infarct
    • Ocular Dipping

    • 004-1
    • The patient is a 32 year old woman with juvenile diabetes mellitus. She collapsed at home and was rushed to the emergency room where a diagnosis of a locked-in syndrome was made. The term Locked-in Syndrome (LiS) was coined in 1966 by Plum and...
    • Ocular Dipping; Bilateral Horizontal Gaze Palsy; Full Vertical Gaze; Locked In Syndrome; Embolic Basilar Artery Occlusion; Bilateral Pontine Infarction; Pontine Infarct; Comatose Patient
    • Ocular Flutter

    • 162-4
    • This little boy complained of difficulty focusing. On examination he was found to have ocular flutter. He was otherwise neurologically intact and in good general health. Investigations were directed to rule out 1. ...
    • Idiopathic Ocular Flutter;
    • Ocular Flutter

    • 166-2
    • This patient was seen in the Neurovisual Clinic for evaluation of a monocular attack of optic neuritis which completely resolved. Six months later, she became unsteady walking and was found to have bilateral ataxia. She was given a diagnosis of...
    • Ocular Flutter; Multiple Sclerosis; Lid Flutter; Multiple Sclerosis Ocular Flutter
    • Ocular Motor Apraxia

    • 162-6
    • This elderly patient was referred to the Movement Disorder Clinic for evaluation of abnormal head thrust movements when asked to look on command to the right or to the left. His random eye movements were full vertically and...
    • Acquired Ocular Motor Apraxia; CNS degenerative disease; Head Thrust; Frontotemporal Dementia; Ocular Motor Apraxia;
    • Oculomasticatory Myorhythmia

    • 042-1
    • This case, previously reported in 1986, is published courtesy of John Selhorst, M.D., Saint Louis University School of Medicine, St. Louis, MO. (4) The patient is a 46 year old man who, over a period of six months, lost the ability to read and...
    • Somnolence; Supranuclear Paralysis of Up and Downgaze; Pendular Vergence Oscillations; Oculomasticatory Myorhythmia; Tropheryma Whippelii – Infection; CNS Whipple's Disease; Supranuclear Paralysis of Up and Downgaze Infection-Whipple's Disease;...
    • Opsoclonus -- In the Dark

    • 166-12
    • N/A
    • Saccadic Oscillations; Paraneoplastic Opsoclonus; Oscillopsia; Opsoclonus; Saccadomania
    • Palatal Tremor

    • 003-2
    • This patient presented with an acute brainstem stroke with: 1. A unilateral lower motor neuron (LMN) facial palsy on the right 2. A horizontal gaze palsy to the right 3. Mild unsteadiness walking The infarct localized clinically to the right side...
    • Palatal Tremor (Myoclonus); Pendular Vertical Oscillations; Unilateral Horizontal Gaze Palsy; Facial Palsy; Pontine Infarct; Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillain-Mollaret Triangle; Oculopalatal Myoclonus;...
    • Palatal Tremor

    • 936-4
    • The patient is a 44 year old left handed man with a history of IV drug abuse (heroin and cocaine) alcoholism, hypertension, and rheumatic fever. In March 1990, at 3 a.m. on the day of admission, he had acute onset of dizziness, slurred speech,...
    • Pendular Vertical Oscillations; Lid Nystagmus; Bilateral Horizontal Gaze Palsy; Palatal Tremor (Myoclonus); Pontine Hemorrhage; Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillain - Mollaret Triangle; Bilateral...
    • Palatal Tremor

    • 927-1
    • The patient is a 60 year old woman with insulin dependent diabetes mellitus. She was legally blind as a result of diabetic retinopathy and bilateral vitreous hemorrhage. In 1987, she was admitted to her local hospital with slurred speech and a...
    • Pendular Vertical Oscillations; Palatal Tremor (Myoclonus); Brainstem Infarct; Unilateral Degenerative Hypertrophy of the Inferior Olivary Nucleus; Lesion in the Guillain - Mollaret Triangle; Pontine Infarct;
    • Palinopsia

    • 010-1
    • The patient is a healthy 59 year old woman who presented in 1978 with transiet visual symptoms. The first visual disturbance occurred in December 1978 when suddenly she noted: • Fluttering of vision in the left eye (OS) • The appearance of...
    • Palinopsia; Prosopometamorphopsia; Migraine visual aura with headache; Falx meningioma; Occipital Lobe; Visual Phenomena
    • Parainfectious Opsoclonus

    • 166-6
    • This child was one of a group of children with opsoclonus that I saw with Dr. Cogan in the early 1970’s. This boy carries the diagnosis of parainfectious brainstem encephalitis. In the absence of myoclonus, myoclonic encephalopathy often...
    • Parainfectious Opsoclonus; Saccadic Oscillations;
    • Paralysis of Convergence

    • 945-1
    • The 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...
    • Supranuclear Upgaze Palsy; Convergence Insufficiency;Horizontal Gaze Evoked Rotary Nystagmus; Hydrocephalus; Seizures; Brainstem Glioma;
    • Paraneoplastic Ocular Flutter

    • 936-7
    • The patient is a 58 year old woman with known hypertension. In 1994, two weeks prior to admission she had a dramatic change in behavior with insomnia, agitation and depression. This was accompanied by “ringing of hands and anxiety for no...
    • Ocular Flutter; Oscillopsia; Trunkal Ataxia; Paraneoplastic Cerebellar Syndrome; Small Cell Carcinoma of the Lung; Paraneoplastic Ocular Flutter; Flutter
    • Paraneoplastic Opsoclonus

    • 931-1
    • This patient is the index case of the Anti-Ri antibody, published in Annals of Neurology in 1988 (4). The Anti-Ri antibody is recognized to be a paraneoplastic marker in patients with breast and gynecological malignancies (10). The history of...
    • Opsoclonus; Ocular Flutter; Oscillopsia; Saccadic Oscillations; Paraneoplastic Cerebellar Syndrome; Adenocarcinoma of the Breast; Anti-Ri Antibody; Paraneoplastic Opsoclonus; Paraneoplastic Ocular Flutter; Saccadomania
    • Paraneoplastic Opsoclonus; Downbeat Nystagmus

    • 936-8
    • The patient is Case 27-1995 Case Records of the Massachusetts General Hospital (New Eng. J Medicine 1995, 333:579-586). The discusser was Dr. Elizabeth Engle, Associate Professor of Neurology, Harvard Medical School. The baby girl was born...
    • Downbeat nystagmus; Paraneoplastic opsoclonus; Neuroblastoma; Primary Position Downbeat Nystagmus; Ataxia; Paraneoplastic Downbeat Nystagmus;
    • Paraneoplastic Opsoclonus/Flutter

    • 166-1
    • In 1975 this patient presented with oscillopsia due to opsoclonus with ocular flutter. Opsoclonus with flutter is a paraneoplastic syndrome associated with occult cancer of the breast, ovary and lung. This patient had cancer of the breast. ...
    • Opsoclonus; Ocular Flutter; Paraneoplastic Cerebellar Syndrome; Adenocarcinoma of the Breast; Paraneoplastic Opsoclonus; Paraneoplastic Ocular Flutter;
    • Paraneoplastic Upbeat Nystagmus

    • 212-3
    • This case was presented to the Clinical Eye Movement Society at the American Neurological Association Meeting in October 2009. The patient is a 65 year old woman who was in good health until seven weeks prior to admission. On June 22/09 on the...
    • Upbeat Nystagmus; Lid Nystagmus; Square Wave Jerks (Saccadic Oscillations); Saccadic Dysmetria; Saccadic Pursuit; Paraneoplastic Syndrome; Paraneoplastic Upbeat Nystagmus; Pancreatic Endocrine Carcinoma; Anti-Hu – Associated Paraneoplastic...
    • Paroxysmal Skew Deviation

    • 169-37
    • In 1970 I saw this unique case with Dr. Cogan. The patient is a 60 year old hypertensive woman with a ten year history of intermittent vertical double vision and oscillopsia. Neurological examination between attacks of diplopia showed: Visual...
    • Paroxysmal Skew Deviation; Ocular Tilt Reaction; Otolith-Ocular Pathway; Skew Deviation
    • Pendular Horizontal Oscillations

    • 941-3
    • This 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...
    • 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...
    • Pendular Nystagmus; Horizontal Gaze Palsy

    • 946-8
    • The patient is a 29 year old retarded man with a rare autosomal recessive disorder characterized by congenital absence of conjugate horizontal eye movements, preservation of vertical gaze and convergence and horizontal pendular nystagmus. Ocular...
    • Horizontal Pendular Nystagmus; Congenital Horizontal Gaze Palsy; Preservation of Convergence; Normal Vertical Gaze; Optokinetic Nystagmus Absent; Horizontal Vestibular Ocular Reflex Absent; Mutation of the ROBO 3 Gene on Chromosome...

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