Neuro-Ophthalmology

Recurrent Benign Sixth Nerve Palsy A young patient presented with acute onset of crossed eyes and diplopia. He reported no associated vision changes in either eye. His examination revealed right eye esotropia of 6 prism diopters (PD) in primary gaze, 14 PD in right gaze, and 4 PD in left gaze. The …

Myelin Oligodendrocyte Glycoprotein Antibody Disease A middle-aged patient was referred from an outside facility for follow up of idiopathic intracranial hypertension. On careful review, she was found to have demyelinating disease on a prior MRI. Patient underwent a repeat MRI which did not demonst…

This patient presented with a one day history of severe pain, reduced vision, diplopia, and proptosis. Imaging revealed a superior ophthalmic vein thrombosis. Extensive workup showed no definite underlying etiology. The patient was started on antibiotics, corticosteroids, and anticoagulation. There…

Recurrent Idiopathic Neuroretinitis A patient presented with 1 day of decreased vision in 2016. Exam disclosed OS>>OD optic nerve edema with visual field defects without other findings. The patient was treated with steroids without much improvement and lost to follow up. The patient then over…

Superior Ophthalmic Vein Thrombosis with likely Cavernous Sinus Thrombosis A patient presented to the ophthalmology emergency room with a 1 day history of periorbital edema, decreased vision, pain with extraocular movements, and diplopia. Evaluation showed proptosis with significant injection and e…

Miller Fisher Syndrome A patient with no significant PMH presented with acute onset of diplopia associated with loss of balance 2 weeks after having an influenza infection. On examination: a bilateral limitation in adduction with end gaze nystagmus in the abducted eye was noted. Also, dilated and n…

Idiopathic Intracranial Hypertension A patient presented with two weeks of vision loss alongside a year-long complaint of left-sided neck stiffness and headaches. Past medical history was remarkable for end-stage renal disease on peritoneal hemodialysis. Examination was notable for blood pressure o…

Neuromyleitis Optica A child presented to the ER with blurry vision and eye pain. Exam disclosed unilateral optic nerve edema and decreased color vision; subsequent MRI disclosed optic neuritis. Lab testing demonstrated +Aqp4 antibodies, and the patient subsequently developed longitudinally extensi…

Idiopathic Intracranial Hypertension A patient with slow and progressive, painless, visual decline OD for two weeks presents to BPEI ED. She also notes moderate intensity full-day headaches and TVOs in the same time period. She saw an outside provider and was referred to BPEI ED for optic nerve hea…

Nuclear 3rd CN Palsy with Vertical Gaze Palsy A patient with significant vasculopathy risk factors (DM, HTN, dyslipidemia), had a stroke affecting the right thalamus, midbrain, and right cerebellum due to basilar artery occlusion. He had a successful mechanical thrombectomy with a stent retriever a…

Infiltrative Optic Neuropathy secondary to Pleomorphic Mantle Cell Lymphoma A patient presented to the ophthalmology emergency room with a 2-day history of decreased vision of his left eye. Examination revealed vision of 20/25 OD and 20/50 OS, with a relative afferent pupillary defect in the left e…

Radiation Optic Neuropathy A patient with a history of proton beam therapy for a chordoma near the clivus presented with 1 week of blurry vision in the left eye. On presentation, patient’s exam was notable for a visual acuity of 20/25 in the right eye and 20/50 in the left eye. Intraocular pressu…

Ethambutol Induced Optic Neuropathy A patient with a past medical history of chronic Mycobacterium avium infection, on anti-mycobacterial medication for 5 months, presented with bilateral, painless, progressive visual loss for 1 month. Previous medical history significant for B cell lymphoma and ma…

Prothrombin G20210A Mutation and Hyperhomocysteinemia in Young Patient with Non-Arteritic Ischemic Optic Neuropathy A patient devoid of significant medical history presented with a sudden onset of painless vision loss in his right eye upon awakening. While the anterior segment appeared unremarkable…

Posterior Cortical Atrophy Variant of Alzheimer's Disease A patient presented for evaluation of optic nerve atrophy and gradually progressive, painless visual distortions for 3 years. She reported difficulty keeping track of characters while reading, judging the speed of other moving vehicles, calc…

Leber's Hereditary Optic Neuropathy A patient came to ED due to subacute decreased vision in his right eye since 1/2023. He had a history of decreased vision in his left eye following phacoemulsification surgery in Oct 2022. BCVA was 20/70 OD and 20/400 OS Past medical history was positive for HTN,…

Tolosa Hunt Syndrome Tolosa Hunt Syndrome is an idiopathic inflammatory process of the cavernous sinus of unknown etiology. There are no known risk factors, but an inciting event, such as a viral illness, vaccination, trauma, or tumors, are known to be preceding events that result in nonspecific in…

Downbeat Nystagmus A patient was referred with double vision and oscillopsia. He reported to have nystagmus and oscillopsia for a few years, and recently mild worsening. He denies head trauma, weakness, numbness, changes in his vision, transient visual loss, or headache. Patient has trouble reading…

Subperiosteal Orbital Hematoma A patient with a history of chronic pansinusitis and absence of midline nasal cavity structures due to chronic inhalational cocaine usage, presents with acute onset left-sided proptosis. She was found to have a non-traumatic, spontaneous subperiosteal orbital hematoma…

Bartonella Neuroretinitis A patient presented with subacute painless decreased vision in the left eye. On examination, she had evidence of stellate macular exudates in the left eye, as well as optic disc edema in the right eye. Imaging including fluorescein angiography and OCT of the macula and ret…