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Proceedings of the 34th Annual Upper Midwest Neuro-Ophthalmology Group Meeting, July 26, 2013, Chicago, Illinois, USA

The 34th annual meeting of the Upper Midwest Neuro-Ophthalmology Group (UMNOG) was held on July 26, 2013, at Northwestern University, Chicago, Illinois. Thirty participants, including four fellows and one resident physician, benefited from the collegiality and spirited discussion that have characterised this forum since its inception. The organisation and direction of the event were performed by Dr. Ivy Dreizin, University of Wisconsin, Madison, Wisconsin, who also expertly kept the pace of the proceedings moving forward. Dr. Walter Jay, Loyola University, Maywood, Illinois, began the day with a case of Horner’s syndrome in a patient with neuromyelitis optica (NMO). Her condition was confirmed by a positive apraclonidine test, the presence of anti-aquaporin-4 antibodies, and a criteria-meeting, contrast-enhancing lesion of the cervical spinal cord. Discussion focused on the rarity of such a presentation and the question was raised why Horner’s syndrome is not noted as frequently with cervical cord lesions as one would expect, given the typical course of the sympathetic pathway from the hypothalamus to the pupil. The discussion of NMO continued with a presentation by Dr. Bonnie Keung, University of Illinois at Peoria, Peoria, Illinois, that stimulated a lively discussion on the nature of NMO spectrum disorder. The patient, who was just 12 years old at presentation, had a positive anti-aquaporin-4 antibody test and prominent enhancing lesions of the diencephalon and brainstem, but no optic nerve or spinal cord involvement. Biopsy of the lesion done rapidly after initial onset of symptoms did not show characteristic demyelination, a fact that brought about discussion of the nature of NMO spectrum disorder itself. Dr. Robert Tomsak, Kresge Eye Institute, Detroit, Michigan, presented a case of a 66-year-old patient with bilateral, sequential non-arteritic ischaemic optic neuropathy (NAION). The ongoing search for effective treatment of NAION was the central focus of the group’s discussion, and the possible utility of erythropoietin or memantine sparked discussion that continued over e-mail since the meeting. Dr. Rashmi Varma, neuro-ophthalmology fellow, University of Michigan, Ann Arbor, Michigan, presented the case of a 33-year-old man status post motor vehicle accident with facial fracture and delayed onset of periocular pain, bruising, chemosis, subconjunctival haemorrhage, and manifest esotropia. Although carotid-cavernous fistula was initially suspected, an angiogram revealed no such pathology. Due to increased watery discharge from the eye upon leaning forward, a diagnosis of cranio-orbital fistula with occulorhoea was considered. This was confirmed via subconjunctival fluid aspiration, which revealed the presence of beta-2 transferrin. The importance of