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Shirley H Wray, m.d, ... (37)
Shirley H Wray, m.d, ... (3)

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Hypertropia Superior O... (2)
Bilateral Sixth Nerve ... (1)
Bilateral Sixth Nerve ... (1)
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1. Fourth Nerve Palsy Fourth Nerve Palsy Hypertropia; Superior Oblique Paresis; Inferior Oblique Overaction; Fourth Nerve Palsy; Trochlear Nerve; Bielchowsky Test; Head Tilt; 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...

2. Fourth Nerve Palsy Fourth Nerve Palsy Hypertropia; Superior Oblique Paresis; Inferior Oblique Overaction; Fourth Nerve Palsy; Trochlear Nerve; Bielchowsky Test; Head Tilt; 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...

3. Third Nerve Palsy Third Nerve Palsy Ptosis; Unilateral Third Nerve Palsy; Microinfarct Third Nerve; Oculomotor Nerve; Unilateral Oculomotor Third Nerve Palsy; The patient is a 57 year old man who carried a diagnosis of atrial fibrillation and coronary artery disease post CABAG. He was seen in the Massachusetts General Hospital ER with acute double vision and...

4. Third Nerve Palsy Third Nerve Palsy Ptosis; Unilateral Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Paresis of Abduction; Sixth Nerve Palsy; Oculomotor Nerve; Cavernous Sinus Meningioma; Cavernous Sinus Syndrome; Unilateral Oculomotor Third Nerve Palsy; Unilateral Sixth Nerve Palsy; This patient is a 46 year old woman from Portugal who was admitted to the Massachusetts General Hospital in September 1986 with ophthalmoplegia of the left eye (OS) and signs of aberrant reinnervation...

5. Nuclear Third Nerve Palsy Nuclear Third Nerve Palsy Nuclear Third Nerve Palsy; Bilateral Ptosis; Bilateral Superior Rectus Palsy; Normal Pupils; Midbrain Infarct; Oculomotor Nerve; 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...

6. Fascicular Third Nerve Palsy Fascicular Third Nerve Palsy Ptosis; Fascicular Third Nerve Palsy; Fixed Dilated Pupil; Contralateral Limb Ataxia; Claude’s Syndrome; Midbrain Infarct; Oculomotor Nerve; Unilateral Third Nerve Palsy; 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...

7. Third Nerve Palsy Third Nerve Palsy Ptosis; Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Oculomotor Nerve; Parasellar Meningioma; Cavernous Sinus Syndrome; Unilateral Oculomotor Third Nerve Palsy; Unilateral Third Nerve Palsy; This patient is a 58 year old woman from Peru who, in 1975, developed intermittent headaches and right retro-orbital eye pain. She was seen by several ophthalmologists in South America who were unable...

8. Sixth Nerve Palsy Sixth Nerve Palsy Sixth Nerve Palsy; Esotropia; Gradenigo’s Syndrome; Unilateral Sixth Nerve Palsy; The patient is a 45 year old pharmaceutical executive who, nine days prior to admission, flew back from San Francisco after a hectic business trip feeling jet lagged and fatigued. Inspite of this, four...

9. Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS Non-Hodgkin’s Lymphoma; Cavernous Sinus Syndrome; 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...

10. Third Nerve Palsy Third Nerve Palsy Ptosis; Unilateral Third Nerve Palsy; Oculomotor Nerve; Microinfarction; Unilateral Oculomotor Third Nerve Palsy; The patient is an 85 year old man with hypertension and Type II diabetes mellitus. He presented with a ten day history of drooping of the left eye, unaccompanied by eye pain or headache. With the lid elevated...

11. Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy; Bilateral Esotropia; Paraneoplastic Opsoclonus/Flutter; Paraneoplastic Cerebellar Syndrome; Carcinoma of the Breast; Paraneoplastic Opsoclonus; 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...

12. Third Nerve Palsy; Aberrant Reinnervation Third Nerve Palsy; Aberrant Reinnervation Ptosis; Unilateral Third Nerve Palsy; Aberrant Reinnervation of the Third Nerve; Pupil Dilated and Fixed; Oculomotor Nerve; Cavernous Sinus Meningioma; Cavernous Sinus Syndrome; The 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...

13. Third Nerve Palsy Third Nerve Palsy Ptosis; Unilateral Third Nerve Palsy; Oculomotor Nerve; Meningovascular Syphilis; Heubner’s Arteritis; Unilateral Oculomotor Third Nerve Palsy; The patient is a 50 year old man with Type II Diabetes who presented to an outside hospital in September 1996 with ptosis and an inability to open the right eye. Five months prior to admission (PTA), he...

14. Unilateral Horizontal Gaze Palsy Unilateral Horizontal Gaze Palsy Unilateral Horizontal Gaze Palsy; Esotropia; Fascicular Sixth Nerve Palsy; Horizontal Gaze Evoked Nystagmus; Normal Convergence; Horizontal Oculocephalic Reflexes Absent; Facial Palsy (Bell's Palsy); Abducens Nuclear Lesion; Pontine Metastasis; Adenocarcinoma of the Breast; Unilateral Sixth Nerve Palsy; Unilateral Horizontal Gaze Palsy Metastasis; This 56 year old woman with known adenocarcinoma of the breast presented with the recent onset of horizontal diplopia and deviation of her left eye inwards. Her oncologist referred her for a neuro-ophthalmic...

15. Sixth Nerve Palsy Sixth Nerve Palsy Esotropia; Abduction Weakness; Sixth Nerve Palsy; Clivus Chordoma; Unilateral Sixth Nerve Palsy; This 46 year old patient had at age 6, a tendency for the left eye to wander out. Her face photograph at that age shows an exotropia and at age 7, a year later, the exotropia was not quite as prominent....

16. Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy; Bilateral Esotropia; CNS B-Cell Lymphoma; 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...

17. Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy Esotropia; Bilateral Abduction Weakness; Bilateral Sixth Nerve Palsy; Clivus Meningioma; 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....

18. Supranuclear Paralysis of Upgaze Supranuclear Paralysis of Upgaze Supranuclear Paralysis of Upgaze; Convergence Retraction Nystagmus; Eyelid Retraction - Collier's Sign; Normal Downgaze; Esotropia; Sixth Nerve Palsy; Dorsal Midbrain Syndrome; Obstructive Hydrocephalus; Aqueduct Stenosis; Medulloblastoma; Increased Intracranial Pressure; Unilateral Sixth Nerve Palsy; This young child presented with headache and unsteadiness. He was found to have obstructive hydrocephalus, aqueduct stenosis and a medulloblastoma. The constellation of clinical eye signs localized to...

19. Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy Bilateral Sixth Nerve Palsy; Esotropia; Supranuclear Paralysis of Downgaze; Absent Convergence; Upbeat Nystagmus on Upgaze; Wernicke’s Disease; Supranuclear Paralysis of Downgaze Encephalopathy; 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...

20. Bilateral Ptosis Bilateral Ptosis Nuclear Third Nerve Palsy; Bilateral Ptosis; Central Caudal Nucleus; Midbrain Ptosis; Oculomotor Nerve; 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...
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