grand rounds conference n.
Skip this Video
Download Presentation
Grand Rounds Conference

Loading in 2 Seconds...

play fullscreen
1 / 19

Grand Rounds Conference - PowerPoint PPT Presentation

  • Uploaded on

Grand Rounds Conference. Janelle Fassbender , MD, PhD University of Louisville Department of Ophthalmology and Visual Sciences July 18, 2014. Subjective. CC: Neurologist requesting full exam HPI : 15 year old girl with epilepsy referred to pediatric ophthalmology by her neurologist.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Grand Rounds Conference' - kareem-livingston

Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
grand rounds conference
Grand Rounds Conference

Janelle Fassbender, MD, PhD

University of Louisville

Department of Ophthalmology and Visual Sciences

July 18, 2014


CC: Neurologist requesting full exam

HPI: 15 year old girl with epilepsy referred to pediatric ophthalmology by her neurologist.


POH: Strabismus surgery 3 years prior by outside ophthalmologist

PMH: epilepsy, asthma, attention deficit disorder

Eye Meds: None

Meds: lamotrigine, oxcarbazine, lisdexamfetamine

Allergies: NKDA



BCVA: 20/25 20/25

Pupils: 5 to 3 mm OU, No RAPD

IOP: 17 17

EOM: Full Full

CVF: Superonasal Superotemporal defect defect


Slit Lamp Exam:

External/Lids Normal OU

Conjunctiva/Sclera Normal OU

Cornea Clear OU

Anterior Chamber Deep, quiet OU

Iris Normal OU

Lens Clear OU

VitreousNormal OU

dilated fundus exam
Dilated Fundus Exam



*Inferior camera artifact

visual fields 24 2
Visual Fields (24-2)



Left superior homonymous quandrantanopia

pre operative mri brain
Pre-operative MRI Brain

Normal brain MRI

*Patient is rotated on table, yielding asymmetry between right and left lobes.

post operative mri brain
Post-operative MRI Brain

Anterior, inferior and lateral resection of temporal lobewith cystic hygroma and normal post-operative changes.

  • Left superior quandrantanopia secondary to right temporal lobectomy for temporal lobe epilepsy.
follow up
  • Year 2
    • Stable visual field defect
the visual pathway
The Visual Pathway
  • High anatomical variability in the optic radiations
    • Up to 15 mm anteriorly and 15 mm posteriorly (Winston, 2013).
optic radiations
Optic Radiations
  • 3 Bundles (Winston, 2013):
    • Anterior bundle (Meyer’s Loop) – Sharp inferolateral turn to end in lower calcarine fissure
    • Central bundle – passes lateral and posterior to the occipital pole
    • Posterior bundle – direct posterior course to the upper calcarine fissure
optic radiations1
Optic radiations

Patient post-op

Diffusion tensor tractography – representative image (Bartroli, 2010)

temporal lobe surgery
Temporal lobe surgery
  • Temporal lobe resective surgery (Georgiadis, 2013):
    • Broad range of surgical options: Anterior temporal lobe resection, selective amygdalohippocampectomy
    • Newer approaches may spare optic radiations (Winston, 2013)
visual field defects following temporal lobectomy
Visual field defects following temporal lobectomy
  • Visual field defects – 50-100%
    • Most commonly superior quadrantanopia(Piper et al, 2014)
  • Other noted complications (Georgiadis, 2013):
    • Trochlear nerve palsy – 2.6 to 19%
    • Transient oculomotor nerve palsy – 2.1%
    • Hemiparesis – 4.6%

Population receptive field analysis of primary visual field cortex complements perimetry in patients with homonymous visual field defects.Papanikolaou A, et al. 2014. PNAS, 11(16):E1656-1665.

  • Visual cortex activity outside of scotoma expected from automated perimetry.
  • Krolak-Salom P, et al. 2000. Anatomy of optic nerve radiations as assessed by static perimetry and MRI after tailored temporal lobectomy. British Journal of Ophthalmology, 84:884-889.
  • Piper RJ, et al. 2014. Application of diffusion tensor imaging and tractography of the optic radiation in anterior temporal lobe resection for epilepsy: A systematic review. Clinical Neurology and Neurosurgery, 124:59-65.
  • Fong KCS. 2003. Eye, 17:330-333.
  • Winston GP. 2013. Epilepsia, 54(11): 1877-1888.
  • Papanikolaou A, et. Al. 2014. Proc Natl Acad Sci U S A, 111(16): E1656–E1665.
  • Georgiadis et al. 2013. Epilepsy Research and Treatment.
  • Bartroli V. 2010.