August 2014 - Volume 20 - Issue 4, Neuro-ophthalmology
pp: 765-1160








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Creator: Steven L. Lewis, MD, FAAN
Duration: 17:05
CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
Steven L. Lewis, MD, FAAN, Editor-in-Chief of Continuum: Lifelong Learning in Neurology provides an ...

Creator: Marc Dinkin, MD
Duration: 00:14
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video of the same patient as in Supplemental Digital Content 8-1 shows an exotropia (reflective of left medial rectus weakness) and a left hypotropia (reflective of left superior rectus and inferior oblique weakness). Notice how the movements of the right eye are greater than the left eye during the test, even though it is not the paretic eye; the left eye is unable to move because of paresis. The deviation of the right eye (there is both an exotropia and hypertropia) is an example of a secondary deviation and results from the Hering law of equal innervation, which states that an equal force is provided to each eye.
Creator: Marc Dinkin, MD
Duration: 00:40
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
Video shows a 75-year-old man who developed gradually progressive proptosis and ptosis in his left eye accompanied by an oblique diplopia. Visual field loss and a relative afferent pupillary defect ensued in the left eye as well. Neuro-ophthalmic examination reveals that the left eye is depressed and deviates laterally in primary gaze. Testing of versions show a lack of adduction and elevation of the left eye, and limited depression which, along with ptosis, is consistent with a left oculomotor palsy. Abduction of the left eye is also limited, consistent with a left abducens palsy.
The presence of a left oculomotor palsy and an ipsilateral abducens palsy is suggestive of either cavernous sinus syndrome or orbital apex syndrome. In this case, however, the presence of an optic neuropathy (not shown), which would not occur from a cavernous sinus lesion, is the clue that the site of the lesion is the orbital apex. The proptosis is also most consistent with an orbital apex mass, and MRI with contrast (see axial and coronal images at end of video) revealed a large left orbital apex meningioma in this patient.
Creator: Matthew J. Thurtell, MBBS, FRACP
Duration: 00:25
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video shows a 63-year-old woman with macrosaccadic oscillations following resection of a breast cancer metastasis to the cerebellum. Note that the macrosaccadic oscillations are triggered by gaze refixations and that her horizontal saccades are hypermetric.
Creator: Matthew J. Thurtell, MBBS, FRACP
Duration: 00:24
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video shows an 18-year-old woman with oculopalatal tremor that developed several months after a pontine hemorrhage. Note that the nystagmus is very disconjugate, being predominantly horizontal in the right eye and vertical-torsional in the left eye. The patient also has synchronous palatal oscillations.
Creator: Matthew J. Thurtell, MBBS, FRACP
Duration: 00:34
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video shows a 44-year-old woman with multiple sclerosis and horizontal acquired pendular nystagmus. The patient also has vision loss in both eyes secondary to optic neuropathy. Note that the nystagmus is more prominent in the left eye, which is the eye with greater vision loss.
Creator: Matthew J. Thurtell, MBBS, FRACP
Duration: 00:45
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video shows a 48-year-old man with upbeat and gaze-evoked nystagmus caused by Wernicke encephalopathy following gastric bypass surgery. The upbeat nystagmus is atypical in that it is less prominent with upward gaze. Note the gaze-evoked nystagmus on lateral gaze.
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