By Jonathan D. Trobe MD
This name within the quick analysis in Ophthalmology sequence provides a wealth of full-color photographs - in addition to differential diagnoses - in side-by-side web page layouts to aid you in selecting a whole variety of neuro-ophthalmic issues. A templated layout expedites entry to the counsel you want to diagnose the commonest stipulations regarding Neuro-Ophthalmology - from easy to advanced - encountered in practice.Coverage of state of the art subject matters together with temporary visible loss, congenital and bought optic neuropathies, chiasmal and retrochiasmal imaginative and prescient problems, nystagmus, and lots of extra, assist you retain your wisdom as much as date.Hundreds of full-color photographs current stipulations as they found in genuine life.Common diagnostic pitfalls talk about what to appear out for while creating a tough prognosis. A templated, color-coded structure and differential prognosis containers for every assist you make quickly, actual medical decisions.A specialise in the commonest stipulations encountered in perform helps you to successfully formulate cures and referrals.SERIES EDITORS: Jay S. Duker, MD, Director, New England Eye heart, Vitreoretinal ailments and surgical procedure carrier; Director, Pediatric Retinal Referral middle, Uveitis & Immunology provider; Professor and Chair of Ophthalmology, Tufts college college of medication, Boston, MA and Marian S. Macsai, MD, leader, department of Ophthalmology, Evanston Northwestern Healthcare; Professor and Vice-Chair of the dep. of Ophthalmology, Feinberg tuition of medication, Northwestern college, MI
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Additional info for Rapid Diagnosis in Ophthalmology Series: Neuro-Ophthalmology
Neuropathology of Vision. An Atlas.
A) Postcontrast coronal T1 MRI shows high signal around the right optic nerve. (B) Postcontrast axial T1 MRI shows that the abnormality affects the orbital and intracanalicular segment of the optic nerve (arrow). These imaging ﬁndings can be mimicked by inﬂammatory diseases such as sarcoidosis. Optic Nerve Sheath Meningioma B 53 Craniopharyngioma Key Facts • Benign partially cystic congenital tumor originating in sella turcica from remnants of pharyngeal epithelium • May cause clinical symptoms at any age • Brain MRI is often diagnostic • Treat with cautious resection followed by radiation • Recurrent visual loss from tumor cyst formation is common Clinical Findings SECTION 3 • Acquired Optic Nerve or Chiasm Disorders • Reduced visual acuity and/or visual ﬁeld (hemianopic defect in at least one eye) • In children, visual loss sometimes accompanied by headache, hypopituitarism (especially growth retardation), papilledema, ventriculomegaly, and increased intracranial pressure • In adults, visual loss is the principal symptom but hypopituitarism may occur • Afferent pupil defect is common • Temporal hemianopic defects are common • Optic discs may appear normal, swollen, small, or pale Ancillary Testing • Brain imaging may be diagnostic in showing mass with heterogeneous signal high on T1 sequences • Blood tests may show hypopituitarism Differential Diagnosis • Other mass lesions of sellar region (pituitary adenoma, aneurysm, meningioma, germinoma, dermoid or epidermoid, arachnoid cyst, optic glioma, metastatic cancer, multiple myeloma, chordoma, chondrosarcoma, vascular malformations, histiocytosis, primitive neuroectodermal tumor, lymphoma) • Sphenoid sinusitis or mucocele • Lymphocytic hypophysitis • Pituitary abscess • Multiple sclerosis • Sarcoidosis • Radiation damage Treatment • Transcranial cautious resection and decompression of cysts • Ventriculoperitoneal shunt for unremitting hydrocephalus • Postoperative high-dose radiation Prognosis 54 • Natural history is progressive visual loss from further tumor growth • Surgery occasionally improves vision, especially if cysts are decompressed • Main purpose is to provide reduced tumor burden so that radiation may be more effective • Aggressive resections associated with permanent worsening of vision • Radiation doses >5000 cGy are necessary to prevent further tumor growth but place patient at risk for radiation optic neuropathy (see Radiation optic neuropathy) and other intracranial radiation complications • Acute visual loss relapses resulting from cyst expansion can often be surgically decompressed but may require permanent drain or radionuclide ablation Craniopharyngioma Fig.
The pathology of traumatic optic neuropathy may look like this. (From Lindenberg R et al. Neuropathology of Vision. An Atlas.