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Clinical Examination in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Selvakumar Ambika, Krishnakumar Padmalakshmi
Optokinetic nystagmus drum is beneficial in assessing the vision in infants (Figure 1.4). It elicits jerk nystagmus with a slow phase following the target and a corrective jerk in the opposite direction. The degree of visual acuity can be assessed based on the size of target. The preferential looking test and visual-evoked potential (VEP) is also used to estimate visual acuity in infants. For older children, HOTV charts and Illiterate E test or pictorial charts can be used.2,3
Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
Although both may cause reduced visual acuity, disproportionally severe dyschromatopsia and presence of RAPD suggest optic neuropathy. Functional visual pathway testing such as visual evoked potential (VEP) or electroretinogram (ERG), and structural retinal imaging with optical coherence tomography (OCT) can help distinguish between these two causes of central vision loss.
Visual conversive syndrome disorder: a Case Report
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
E. Lala, M.L. Le Lez, J. Malvy, F Madern, P.J. Pisella, S. Arsène
Case report:Marion, a 16 years old girl, has consulted in emergency for an isolated right eye ‘s positive scotoma, which appeared five days ago.Visual acuity was conserved, clinical ophthalmological examination was normal, without any abnormality of fundus neither pupillary reflex.The scotoma was found in the inferio-temporal visual field, non-systematised, in two successive exami- nations. Neither the angiofluorography, neither the cerebral CTscan, neither visual evoked potential showed any organic damage. Ultimately, the scotoma disappeared spontaneously following a nightmare and the psychiatrist diagnosed a visual conversive disorder following upon a conflict.
A Story of Discovery and Change: What We Learned from Studying Nystagmus in Infancy and Childhood
Published in Journal of Binocular Vision and Ocular Motility, 2022
Special testing of the visual system is an important part of the evaluation of a patient with nystagmus since over 70% have other associated visual system abnormalities and more than 50% have an associated systemic condition.4,12,13 The ultimate diagnosis of nystagmus type is dependent on the use of eye movement recordings (EMR) in the same way as arrythmias of the heart are diagnostically dependent on electrocardiographic technology. In addition, all patients should undergo formal color vision testing, electroretinography (ERG), optical coherence tomography (OCT), and fundus photography. We now routinely perform contrast sensitivity testing (CSF) and targeted genetic testing of suspected optic nerve, retinal and syndromic conditions. In those patients with low vision, optic nerve, or cerebral disorders, visual evoked potential testing (VEP) is also performed. We rarely perform central nervous system imaging (MRI or CT Scan).
A 9.5-year-old boy with recurrent neurological manifestations and severe hypertension, treated initially for polyarteritis nodosa, was subsequently diagnosed with adenosine deaminase type 2 deficiency (DADA2) which responded to anti-TNF-α
Published in Paediatrics and International Child Health, 2020
Sezgin Sahin, Amra Adrovic, Kenan Barut, Selen Baran, Eda Tahir Turanli, Nur Canpolat, Osman Kizilkilic, Ozan Ozkaya, Ozgur Kasapcopur
Investigations. Haemoglobin was 9.8 g/dL, haematocrit 31.6%, MCV 59.6 fl, platelets 230 × 109/L, leucocytes 10.7 × 109/L [neutrophils 58%, polymorphonuclear leucocytes (PNL) lymphocytes, 31.0% and monocytes 10.0%]. Erythrocyte sedimentation rate (ESR) was 94 mm/h (<20) and C-reactive protein (CRP) 234 mg/L (<10). Owing to widespread myalgia, muscle enzymes were estimated but were within normal limits, as were analyses of electrolytes, liver and renal function and D-dimer levels. Screening tests for thrombophilia did not yield any tendency to thrombosis. Components of cell-mediated immunity and serum IgA (178 mg/dL), IgM (131 mg/dL) and IgE (20 mg/dL) were within normal limits. However, serum IgG was 1933 mg/dL (reference range for Turkish children aged 9 is 646–1620 [17]. Electromyography and nerve conduction studies of lower limbs demonstrated asymmetrical axonal polyneuropathy. There was no response to visual evoked potential and electroretinogram tests of the right eye. While brain MRI findings were compatible with hypertensive encephalopathy in the left prefrontal cortex, electroencephalography was normal. Conventional cranial and visceral angiography was performed to elucidate the malignant hypertension and neurological findings. Angiography of brain was normal. However, visceral angiography demonstrated irregularities and stenosis in some of the branches of the inferior mesenteric artery and renal interlobar arteries bilaterally (Figures 1 and 2).
Novel retinal findings in peroxisomal biogenesis disorders
Published in Ophthalmic Genetics, 2018
B. E. O’Bryhim, B. A. Kozel, G. T. Lueder
ERG testing may reveal extinction of both cone and rod function. Visual evoked potential (VEP) testing may also be extinguished, depending on the severity of the phenotype(3). Optical coherence tomography in one individual able to comply with testing revealed cystoid macular edema, which may also contribute to reduced visual acuity(8). Other ophthalmologic findings of peroxisomal biogenesis disorders include congenital cataracts, corneal clouding and optic nerve atrophy (1,3). Individuals with diagnosed or suspected to have peroxisomal disorders should undergo screening ophthalmic examination and should receive low vision services when appropriate.