Clinical Methods of Neuro-Ophthalmologic Examination

Clinical Methods of Neuro-ophthalmologic Examination
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Contents:

  • Neuro-ophthalmology: The practical guide
  • Key points
  • Bestselling Series
  • Neuro-Ophthalmology in Emergency Medicine | Anesthesia Key
  • by Kestenbaum, Alfred
  • Neuro-Ophthalmologic Evaluation as a Biomarker for Diagnosis and Progression in Parkinson Disease

    • There was no evidence of ocular inflammation. Ultrasound confirmed the presence of a solid mass at the optic disc and at the macula. Workup for possible metastatic disease was negative. Bartonella serologies were initially negative then showed greater than fourfold rise in titers one month later. We report the first case of a macular mass presumably due to Bartonella inflammation.

    Neuro-ophthalmology: The practical guide

    The presence of multiple mass-like lesions in the absence of systemic or ocular inflammation was suggestive of ocular metastases. We alert the clinician to yet another clinical presentation of cat-scratch disease.

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    Orbital infarction syndrome is uncommon, and results from ischemia of all intraocular and orbital structures. It has been reported in a variety of settings. Cocaine has potent sympathomimetic and vasoactive properties, and has been associated with retinal vascular occlusions. We describe a case of orbital infarction syndrome associated with intranasal cocaine use.

    Key points

    To describe an uncommon syndrome, as well as a previously unreported complication of intranasal cocaine use. A year-old woman presented with sudden, painful visual loss O.

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    The patient has attended a party the previous evening, and consumed alcohol, and intranasal cocaine. She lost consciousness with her left face pressed against a desktop. She awoke with complete blindness in the OS, left orbital pain, left ptosis, left proptosis, and complete left ophthalmoplegia. An urgent MRI, including fat-suppressed orbital views, showed diffuse edema of all left extraocular muscles, but no other abnormalities.

    A cerebral angiogram, performed 48 hours after the patient had awoken, was normal, with questionable delayed choroidal filling.

    Bestselling Series

    She had complete left ptosis, mild periorbital edema, and complete left ophthalmoplegia. The left fundus showed diffuse retinal edema.

    The remainder of her neuro-ophthalmic examination was unremarkable. An extensive inflammatory and hypercoagulable evaluation was unrevealing. She was seen one week later in clinic. The orbital pain was improved. Examination was similar, except for modest improvement in left ductions and left ptosis. The retinal edema had resolved. Orbital infarction has been described in patients with prolonged head compression, as well as a variety of inflammatory and hypercoagulable disorders. The combination of left orbital compression and the vasoactive properties of cocaine resulted in orbital infarction syndrome in this patient.

    This potential complication of intranasal cocaine has not previously been reported. Causes of visual loss include optic atrophy, anterior ischemic optic neuropathy, arterial or venous retinal occlusion, maculopathy, and subretinal neovascular membrane NVM.

    Neuro OSCE (1 of 3) - Cranial Nerve + Upper Extremity

    A previously healthy year-old man presented with left visual loss for 2 weeks. Visual field revealed enlarged blind spot and cecocentral scotoma in the OS. Vitreous cells were present in the OS with a slight inflammation in the left anterior chamber. Fundus examination revealed bilateral swollen optic discs with bilateral temporal superior parapapillary subretinal nodules 1. Results of lumbar puncture and blood serologies for inflammatory and infectious disorders were twice negative. Bilateral parapapillary NVM were suspected. Intraventricular intracranial pressure was continuously monitored revealing nocturnal sustained peaks of hypertension max.

    Lumbo-peritoneal shunt was performed. Parapapillary NVM is a rare event complicating papilledema, as only 10 cases have been thus far reported in the literature.

    Neuro-Ophthalmology in Emergency Medicine | Anesthesia Key

    It is believed to be associated with long-standing papilledema. Indeed half of the reported cases including the present case are asymptomatic until visual loss. To determine the frequency of neuro-ophthalmic findings in patients with unruptured intracranial aneurysms and to correlate patient characteristics and outcome with these findings. A retrospective chart review of consecutive patients with unruptured intracranial aneurysms operated at the University of Florida by a single surgeon ALD between and Analysis was performed on the clinical characteristics of patients with only preoperative or postoperative ophthalmic findings.

    Preoperative presenting ophthalmic findings were analyzed to determine their resolution, improvement, stability, or worsening at final follow-up. Ophthalmic outcomes were correlated with patient age, duration of symptoms prior to surgery as well as size of the aneurysm s.

    by Kestenbaum, Alfred

    Clinical Methods of Neuro-Ophthalmologic Examination presents the clinical methods of ophthalmologic examination that may be helpful in neurologic. Full text. Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (K), or click on a page.

    There was a statistically significant correlation between younger age and improved outcome of the presenting sign or symptom. Furthermore, improved outcome was more likely to occur in patients with small 1—14 mm aneurysms. Of these new findings, ptosis and anisocoria were more likely to improve when compared with ocular motility disturbances.

    Neuro-ophthalmic manifestations are common in patients with unruptured intracranial aneurysms and can often be the presenting feature.

    Neuro-Ophthalmologic Evaluation as a Biomarker for Diagnosis and Progression in Parkinson Disease

    The outcome of ophthalmic findings seems to be related to age of patient and size of the aneurysm. Early surgery was not associated with a greater likelihood of improved ophthalmic outcome. A large proportion of patients with ophthalmic findings have multiple aneurysms, some of which may be remote from the visual and ocular motility pathways. To elucidate the spatiotemporal activity of a cortical network for processing the motion perception, a magnetic encephalographic MEG study was performed in six healthy right-handed subjects. A random dot kinematogram was used for the visual stimuli.

    It consists of white square dots randomly projected on a screen against a global dark background. The subjects were instructed to look at the fixation point at the center of the screen with both eyes. Each dot moved smoothly at a constant speed. Coherent movement of milliseconds duration and random movement of milliseconds were presented alternately.

    During the coherent period, a certain proportion of the total dots i. The magnetic responses were recorded in a magnetically shielded room using a channel whole-head magnetometer. Two components of magnetic fields were observed in the bilateral temporal and occipital areas in all subjects, with right temporal dominance.

    We focused on the first component in the right temporal area as they had large amplitudes and were readily distinguished. As the coherence levels rose, the peak latencies of the first component shortened markedly. Although often considered a sign of elevated intracranial pressure, alternative factors may influence the loss of spontaneous venous pulsations of the optic disk. To evaluate the effect of optic disk edema on spontaneous venous pulsations in the absence of elevated intracranial pressure.

    The proportion of subjects with spontaneous venous pulsations present in both eyes, in the involved eye only, in the uninvolved eye only, and in neither eye was determined. Exact McNemar's test was used to evaluate an effect of optic disk edema on the presence of spontaneous venous pulsations. Venous pulsations were absent in both eyes of seven subjects, and present only in the uninvolved eye of twelve patients.

    No subject had venous pulsations present in both eyes. One patient with ischemic optic neuropathy and segmental optic disk edema had a venous pulsation present on the non-edematous half of the nerve.