History:  This young 2-year-old girl has been diagnosed with porencephaly since she was 2 ½ months old.  She has right hemiparesia.  She fixes and follows pretty well inspite of a vertical saccadic nystagmus (upbeat nystagmus).  Although this cannot be appreciated in the pictures, she has a huge AHP with the chin up.  Fundus examination demonstrates smaller optic discs although they do not appear hypoplastic.  Refraction is OD +2.00 +.50 x 90 and OS +1.00 +1.00 x 90.  She appears to prefer to fix with her right eye. The eye movements are quiet in far down gaze.  The esodeviation as estimated by the pupillary light reflex varies from never less than 30 to as much as 60 prism diopters.  Due to limited cooperation, the six photos presented are all that could be obtained.

Diagnosis:  Upbeat nystagmus with variable esotropia and with severe chin up head posture 

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