In this segment of the 2013 Neuro-Ophthalmology Subspecialty Day series on recognizing distinctive neuro-ophthalmic symptoms, signs, and tests, Paul Phillips presents to panelists Anthony Arnold, Lanning Kline, Mark Kupersmith, and Valerie Purvin the case of a 14-year-old boy who was in his usual state of good health until 1 month ago, when he had headaches, nausea, and vomiting. Two weeks later, he had decreased vision in both eyes and pulsatile tinnitus. He consulted a local ophthalmologist, who diagnosed an "eye infection" and treated him with azithromycin. His symptoms continued and he presented to the ER 2 weeks later.