Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.
-
Upload
elvin-fowler -
Category
Documents
-
view
217 -
download
0
Transcript of Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.
![Page 1: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/1.jpg)
Neuro-ophthalmologyNeuro-ophthalmology
Abdulrahman Al-MuammarAbdulrahman Al-Muammar
College of MedicineCollege of Medicine
King Saud UniversityKing Saud University
![Page 2: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/2.jpg)
Neuro-ophthalmologyNeuro-ophthalmology
Objectives:Objectives:• Recognize and interpret the common signs and Recognize and interpret the common signs and
symptoms of neuro-ophthalmic disorderssymptoms of neuro-ophthalmic disorders
Obtain appropriate historyObtain appropriate history
Measure visual acuityMeasure visual acuity
Examine pupillary reactionExamine pupillary reaction
Test the function of the extraocular musclesTest the function of the extraocular muscles
Evaluate the visual fieldsEvaluate the visual fields
Inspect the optic nerve headInspect the optic nerve head
![Page 3: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/3.jpg)
Neuro-ophthalmologyNeuro-ophthalmology
PupilPupil
Ocular motor systemOcular motor system
Visual systemVisual system
Visual fieldsVisual fields
Common neuro-ophthalmic disordersCommon neuro-ophthalmic disorders
![Page 4: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/4.jpg)
PupilPupil
Pupillary size is determined by number Pupillary size is determined by number of factors includingof factors including
AgeAge
Level of alertnessLevel of alertness
Level of retinal illuminationLevel of retinal illumination
Accommodative effortAccommodative effort
![Page 5: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/5.jpg)
PupilPupil
Anatomy of pupillary pathwayAnatomy of pupillary pathwayAfferent limbAfferent limb
Efferent limbEfferent limb• Parasympathetic pathwayParasympathetic pathway• Sympathetic pathwaySympathetic pathway
Near responseNear response
![Page 6: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/6.jpg)
PupilPupil
![Page 7: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/7.jpg)
Pathway of pupillary reaction to lightPathway of pupillary reaction to light
![Page 8: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/8.jpg)
Sympathetic pathwaySympathetic pathway
![Page 9: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/9.jpg)
Afferent pupillary defect (APD)Afferent pupillary defect (APD)
![Page 10: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/10.jpg)
Afferent pupillary defect (APD)Afferent pupillary defect (APD)
![Page 11: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/11.jpg)
Causes of APDCauses of APD
Optic nerve diseaseOptic nerve disease
Significant retinal diseaseSignificant retinal disease
AmblyopiaAmblyopia
![Page 12: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/12.jpg)
Efferent pupillary defectEfferent pupillary defect
![Page 13: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/13.jpg)
AnisocoriaAnisocoria
![Page 14: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/14.jpg)
AnisocoriaAnisocoria
![Page 15: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/15.jpg)
AnisocoriaAnisocoriaPupillary inequality greatest
In bright light(large pupil)
In dim light(small pupil)
3rd nerve palsyTraumaTumorTemporal lobe herniationAneurysm
No 3rd nerve palsyDrug inducedAdie’s pupilIris damage (trauma/surgery/laser)Basal meningitis
PtosisHorner syndrome
Physiological
![Page 16: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/16.jpg)
AnisocoriaAnisocoria
![Page 17: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/17.jpg)
Horner syndromeHorner syndrome
![Page 18: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/18.jpg)
Ocular motor systemOcular motor system
![Page 19: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/19.jpg)
Ocular motor systemOcular motor system
![Page 20: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/20.jpg)
Ocular motor systemOcular motor system
![Page 21: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/21.jpg)
33rdrd nerve palsy nerve palsy
+ ve pupillary involvement An incomplete III palsy which progress Other neurological signs No resolution in 3 months Aberrant regeneration appears
Emergency Do MRI,MRA If negative do catheter angiography To r/o compressive lesion: aneurysm, tumor Other possible causes : vasculopathy, trauma, inflammatory, demyelination, infectious, MG, congenital
![Page 22: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/22.jpg)
Ocular motor systemOcular motor system
![Page 23: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/23.jpg)
44thth nerve palsy nerve palsy
Most frequent cause is traumaMost frequent cause is trauma
If no trauma, isolated 4If no trauma, isolated 4thth nerve palsy nerve palsy then most likely vasculopathic ( Do BP, then most likely vasculopathic ( Do BP, BS)BS)
+ve trauma, any other neurological +ve trauma, any other neurological signs, normal BP/BS or palsy lasting > 3 signs, normal BP/BS or palsy lasting > 3 months then MRI is needed.months then MRI is needed.
![Page 24: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/24.jpg)
Ocular motor systemOcular motor system
![Page 25: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/25.jpg)
66thth nerve palsy nerve palsy
Isolated 6Isolated 6thth nerve palsy most likely nerve palsy most likely vasculopathic ( do BP/BS)vasculopathic ( do BP/BS)
Normal BP/BS, other neurological signs, Normal BP/BS, other neurological signs, trauma, or palsy > 3 months then do trauma, or palsy > 3 months then do MRIMRI
![Page 26: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/26.jpg)
Visual systemVisual system
![Page 27: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/27.jpg)
Visual systemVisual system
![Page 28: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/28.jpg)
Visual systemVisual system
![Page 29: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/29.jpg)
Visual fields defectVisual fields defect
![Page 30: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/30.jpg)
Visual fields defectVisual fields defect
![Page 31: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/31.jpg)
Visual fields defectVisual fields defect
![Page 32: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/32.jpg)
Visual fields defectVisual fields defect
![Page 33: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/33.jpg)
Visual fields defectVisual fields defect
![Page 34: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/34.jpg)
Visual fields defectVisual fields defect
![Page 35: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/35.jpg)
Optic discOptic disc
![Page 36: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/36.jpg)
![Page 37: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/37.jpg)
Disc swellingDisc swelling
Mechanical signsMechanical signsElevationElevationBlurred marginsBlurred marginsPeripapillary edemaPeripapillary edemaChoroid foldsChoroid folds
Vascular signsVascular signsHyperemiaHyperemiaVenous dilationVenous dilationDisc hemorrhageDisc hemorrhageNFL infarctsNFL infarctsExudatesExudates
![Page 38: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/38.jpg)
Causes of disc swellingCauses of disc swelling
Increased intracranial pressureIncreased intracranial pressureIschemic optic neuropathyIschemic optic neuropathyOptic neuritisOptic neuritisCentral retinal vein occlusionCentral retinal vein occlusionNutritional optic neuropathyNutritional optic neuropathyToxic optic neuropathyToxic optic neuropathy ETOH-ethanol-Digitalis-ETOH-ethanol-Digitalis- Ethambutol -Chloramphenicol-Ethambutol -Chloramphenicol- INHINH
TumorTumorInfiltrativeInfiltrativeOrbital PseudotumorOrbital PseudotumorThyroid orbitopathyThyroid orbitopathy
![Page 39: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/39.jpg)
![Page 40: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/40.jpg)
![Page 41: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/41.jpg)
Amaurosis FugaxAmaurosis FugaxTransient monocular visual loss or dimmingTransient monocular visual loss or dimming
May last from 2-3 minutes to 30 minutes or moreMay last from 2-3 minutes to 30 minutes or more
Due to decrease blood flow to the eyeDue to decrease blood flow to the eye
Causes:Causes:• Carotid atheromaCarotid atheroma• Cardiac valvular diseaseCardiac valvular disease• Atrial myxomaAtrial myxoma• Retinal migraineRetinal migraine• Giant cell arteritisGiant cell arteritis• Hyperviscousity syndromesHyperviscousity syndromes
![Page 42: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/42.jpg)
Myasthenia Gravis (MG)Myasthenia Gravis (MG)
Chronic auto-immune disorder characterized by Chronic auto-immune disorder characterized by presence of antibodies which block the ACH presence of antibodies which block the ACH receptor sitesreceptor sites
It can affect any muscleIt can affect any muscle
Eye signs are the presenting signs in 50% of the Eye signs are the presenting signs in 50% of the patientspatients
• PtosisPtosis• Any ocular motility disturbancesAny ocular motility disturbances• INOINO• Variability is the hallmoarkVariability is the hallmoark
![Page 43: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/43.jpg)
Myasthenia Gravis (MG)Myasthenia Gravis (MG)
DiagnosisDiagnosis• ClinicallyClinically• Pharmacologically (Tensilon test)Pharmacologically (Tensilon test)• SerologicallySerologically• Sleep testSleep test• Ice-pack testIce-pack test• CT chestCT chest• Thyroid function testThyroid function test• ANAANA
TreatmentTreatment• Acetylcholinesterase inhibitorsAcetylcholinesterase inhibitors• SteroidSteroid• ImmunosuppressantImmunosuppressant• PlasmapheresisPlasmapheresis• ThymectomyThymectomy
![Page 44: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/44.jpg)
Multiple sclerosisMultiple sclerosis
Patients with multiple sclerosis (MS) Patients with multiple sclerosis (MS) frequently have visual complaintsfrequently have visual complaints
Cerebellar dysfunctionCerebellar dysfunction
Motor symptomsMotor symptoms
Sensory symptomsSensory symptoms
Mental changesMental changes
Sphincter disturbancesSphincter disturbances
![Page 45: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/45.jpg)
Multiple sclerosisMultiple sclerosis
Ocular complications:Ocular complications:Optic neuritisOptic neuritis
Chiasmal and retro chiasmal abnormalitiesChiasmal and retro chiasmal abnormalities
Ocular motility disturbancesOcular motility disturbances
TreatmentTreatmentSteroidSteroid
InterferonInterferon
![Page 46: Neuro-ophthalmology Abdulrahman Al-Muammar College of Medicine King Saud University.](https://reader033.fdocuments.net/reader033/viewer/2022051516/56649dbf5503460f94ab2e85/html5/thumbnails/46.jpg)
Thank youThank you