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Radiological Interpretation in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Chirag Kamal Ahuja, Paramjeet Singh
Neuro-ophthalmology refers to a subdivision of neurology that relates to diseases of the orbit and visual pathways, as well as certain structures of the brain. It is an intriguing branch wherein, at times, it is difficult to assign its scope with respect to the pathologies that come under its ambit. For the sake of simplification, we would include all pathologies, which are related to visual pathway as well as the central/systemic ones in which the clinical manifestation of the patient relates to either visual disturbances or abnormality in ocular movements, in this chapter.
Programme choice
Published in Fiona Rowe, Visual Fields via the Visual Pathway, 2016
Comparison of kinetic perimetry has been made with static automated central perimetry. Both options, when directly compared, have been shown to reliably detect visual field loss (Keltner et al. 1999; Nowomiejska et al. 2005; Nowomiejska et al. 2009; Nowomiejska et al. 2010; Szatmary et al. 2002; Wong and Sharpe 2000). Central static programmes such as the Humphrey SITA 30-2 strategy have been used most in these studies. Octopus 900 semi-automated kinetic perimetry has also been compared to a Humphrey static peripheral programme (full field 120) for neuro-ophthalmic assessment with moderate agreement for results (Figure 3.24). Generally, Humphrey perimetry test duration was longer than Octopus semi-kinetic perimetry although this was not consistent for all tests. When a more detailed evaluation with Octopus semi-kinetic perimetry was undertaken, this was at times longer than the Humphrey assessment. In the absence of kinetic perimetry options in neuro-ophthalmology clinics, peripheral static suprathreshold programme options such as the full field 120 are useful for detection of visual field defects. Octopus semi-kinetic perimetry utilising both the I4e and I2e targets provides detailed information of both the defect depth and size and may provide a more representative view of the actual visual field defect, particularly for more moderate to severe visual field defects (Rowe et al. 2013).
Double Vision and New Onset Strabismus in an Adult
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Arrange review with the relevant subspecialty for further follow up and orthoptist review. In patients with pain and pupil involving third nerve palsies request an urgent CTA/MRA to rule out an aneurysm.Refer atypical cranial nerve palsies for further investigation with medical/neurological colleagues, i.e. those associated with multiple cranial nerves, headaches, papilloedema or GCA symptoms. Neuro-ophthalmology review can be arranged, priority to those with optic nerve compromise.All other cranial nerve palsies without other neurological signs or symptoms; optimise cardiovascular risk factors. These patients can be monitored by the orthoptic team. If there is no recovery by 3 months further investigations such as imaging may be needed.In patients with suspected myasthenia gravis check that there is no pulmonary involvement; if so urgent referral to the medical team is needed. Refer to neurology for consideration of steroids or pyridostygmine following diagnosis.In thyroid eye disease check that there is no exposure and no acute optic neuropathy; if so high dose steroids may be needed and urgent orbital/oculoplastic review should be arranged.
Biopsy-Proven Giant Cell Arteritis Associated Vision Loss in Chinese Subjects: A Case Series and Review of the Literature
Published in Neuro-Ophthalmology, 2023
Yan Yan, Zhen Li, Yuanyuan Luo, Ping Chen, Lin Liu
Herein we report three Chinese subjects with bilateral vision loss due to BpGCA and have summarised the English literature on BpGCA-associated blindness in Chinese subjects. All three were evaluated, biopsied, and treated by the first author (YY) at the Neuro-ophthalmology clinic, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, consecutively from March to November 2021. We also present the characteristic features of orbital MRI in GCA. Three hundred and fifty patients visited the Neuro-ophthalmology clinic during the same period due to Neuro-ophthalmological diseases. Written informed consent was obtained from all three subjects. The Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine Research Ethics Committee has confirmed that no ethical approval is required for this case series.
Post-operative vision loss: analysis of 587 patients undergoing endoscopic surgery for pituitary macroadenoma
Published in British Journal of Neurosurgery, 2022
John W. Rutland, Jonathan T. Dullea, Eric K. Oermann, Rui Feng, Dillan F. Villavisanis, Shivee Gilja, William Shuman, Travis Lander, Satish Govindaraj, Alfred M. C. Iloreta, James Chelnis, Kalmon Post, Joshua B. Bederson, Raj K. Shrivastava
Preoperative and post-operative ophthalmological results were collected from electronic medical records and included data from an initial office visit, perioperative period, post-operative office visit, neuro-ophthalmological evaluation, and outpatient follow-up. Visual acuity was determined using the Snellen card. In cases with available neuro-ophthalmology, the visual field by Humphrey Visual Field Analyzer (24-2 visual field testing) was used to quantify visual field defect and calculate the mean deviation and pattern standard deviation. Optical coherence tomography (OCT) by Zeiss Cirrus HD-OCT or Heidelberg Spectralis SD-OCT was used to survey the retinal nerve fibre layer (RNFL) in micrometres. The reliability criteria used were fixation losses <30%, as well as false positive and false negative errors <30%. The ocular examination included a slit lamp and dilated fundus examination. Blindness was defined as a lack of light perception in one or both eyes.
Update on Optic Neuritis: An International View
Published in Neuro-Ophthalmology, 2022
Simon J. Hickman, Axel Petzold
The presentation, treatment and visual outcome of optic neuritis have been previously reviewed in Neuro-Ophthalmology in 2008 and 2011.1,2 At the time of these reviews contemporary understanding was that optic neuritis was typical, ie idiopathic or multiple sclerosis (MS) related, associated with a good visual prognosis, or atypical, i.e. not associated with MS and requiring corticosteroids or plasma exchange (PLEX) for vision to recover. The atypical forms were felt to be more likely to be bilateral and more likely to relapse. They could be isolated, as in chronic relapsing inflammatory optic neuropathy, or associated with neuromyelitis optica (NMO) with its serological marker anti-aquaporin 4 (AQP4) antibodies.1 Since then, new diagnostic criteria have been published defining NMO spectrum disorder (NMOSD),3 in revising the MS diagnostic criteria4 and in defining the role of anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibodies in central nervous system demyelinating disorders.5 In addition, optic neuritis has recently been described as occurring as part of anti-glial fibrillary acidic protein antibody-associated meningoencephalitis6 and in association with anti-glycine receptor α1 subunit antibodies.7 These antigens are expressed at high concentrations in the optic nerve, but further work is required to better understand if these antibodies are pathogenic or represent an epiphenomena.