neuro ophthalmology n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
NEURO-OPHTHALMOLOGY PowerPoint Presentation
Download Presentation
NEURO-OPHTHALMOLOGY

Loading in 2 Seconds...

play fullscreen
1 / 25

NEURO-OPHTHALMOLOGY - PowerPoint PPT Presentation


  • 280 Views
  • Uploaded on

NEURO-OPHTHALMOLOGY. Clinical Examination. Visual Acuity Colour Vision Visual Fields Pupils. Normal Eye and Optic Disc. Cupped disc. The swollen optic disc. Papilloedema Papillitis Malignant hypertension Ischaemic optic neuropathy Diabetic optic neuropathy CRVO

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

NEURO-OPHTHALMOLOGY


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
clinical examination
Clinical Examination
  • Visual Acuity
  • Colour Vision
  • Visual Fields
  • Pupils
the swollen optic disc
The swollen optic disc
  • Papilloedema
  • Papillitis
  • Malignant hypertension
  • Ischaemic optic neuropathy
  • Diabetic optic neuropathy
  • CRVO
  • Intraocular inflammation
slide5

25 y.o. female

Reduced VA

Pain with eye movement

Colour desaturation

RAPD

slide6

65 y.o. male

Reduced VA

Painless loss of vision

Essential hypertension

Smoker

the pale optic disc
The pale optic disc
  • Congenital
  • Secondary to
    • raised ICP
    • vascular retinal disease
    • optic neuritis
    • optic nerve compression
    • trauma
  • Glaucoma
papilloedema
Papilloedema

Blurred optic disc margin

  • Disc swelling secondary to raised ICP
  • Headache
    • Worse in the morning
    • Valsalva manouver
  • Nausea and projectile vomiting
  • Horizontal diplopia (VI palsy)
  • Causes
    • Space occupying lesion
    • Intracranial hypertension
      • Idiopathic
      • Drugs
      • Endocrine
    • Severe hypertension

Haemorrhages

Small optic cup

CWS

Disc pallor

Vessel attenuation

pupils
Pupils
  • First Order – Retina to Pretectal Nucleus in B/S

(at level of Superior colliculus)

  • Second Order – Pretectal nucleus to E/W nucleus

(bilateral innervation!)

  • Third Order – E/W nucleus to Ciliary Ganglion
  • Fourth Order – Ciliary Ganglion to Sphincter

pupillae (via short ciliary nerves)

pupil
Constricted (mioisis)

Sympathetic (pupillodilator) denervation

Drugs

Pilocarpine

Morphine

Dilated (mydriasis)

Parasympathetic (pupilloconstrictor) denervation

Lesion of the third CN

Drugs

Atropine

Cocaine

Pupil
horner s
Horner’s
  • Oculosympathetic paresis
    • Ptosis
    • Miosis
    • Ipsilateral anhidrosis
    • Does not dilate with cocaine 4%
sympathetic pathway
Sympathetic Pathway
  • First Order – Posterior Hypothalamus to

Ciliospinal centre of Budge (C8-T2)

(Uncrossed in Brainstem)

  • Second Order – Ciliospinal centre of Budge to

Superior Cervical Ganaglion

  • Third Order – Superior Cervical Ganglion to

dilator pupillae muscle. (Close to

ICA and joins V1 intracranially)

slide14

Internal Carotid Dissection

Herpes Zoster

  • CVA
  • Tumour
  • Otitis Media
  • Tolosa-Hunt Sy.

Pancoast bronchogenic carcinoma

causes of horner s pupil
Causes of Horner’s pupil
  • Central – B/S lesions (tumours, vascular and MS)

Syringomyelia, Lat. Med. Syn., S.C. ca.

  • Preganglionic – Pancoast tumour, Carotid & Aortic

aneurysms, Neck lesions/trauma.

  • Postganglionic – Cluster headaches, Nasopharyngeal

tumours, Otitis media, Cavernous

sinus mass and ICA disease.

  • Miscellaneous – Congenital (brachial plexus injury)

Idiopathic.

afferent efferent defects
Argyll-Robertson pupil

Small, irreg

Does not react to light

Reacts to accommodation

Causes

syphilis

diabetes

Miotonic pupil (Adie’s syndrome)

Dilated

Poor response to light and convergence.

Constricts with weak Pilocarpine

Holmes-Adie syndrome

Reduced tendon reflexes (Knee, ankle)

- Orthostatic hypotension

Afferent & efferent defects
ocular motility abnormalities
Third nerve palsy

Double vision

Eye turned down & out

Ptosis

Dilated pupil & headache

Compressive lesion

Sixth nerve palsy

Double vision

Eye turned in

Ocular motility abnormalities
cranial nerve palsies
Cranial Nerve Palsies

Looking straight ahead

slide19

Posterior communicating artery aneurysm

Chiasma

Posterior cerebral artery

III CN

internuclear ophthalmoplegia
Internuclear Ophthalmoplegia
  • Defective adduction of the ipsilateral eye
  • Nystagmus of the contralateral (abducting) eye
  • NORMAL CONVERGENCE
  • Causes
    • Young patients
      • Bilateral
      • Demyelination
    • Older patients
      • Unilateral
      • Vascular, tumours
myasthenia gravis
Myasthenia Gravis

Fatigability

Double vision

Lid twitch

Ptosis

Normal reflexes & sensation

investigations mg
INVESTIGATIONS MG
  • Anti ACh receptor Ab’s
  • Electromyography
  • Tensilon test
    • Edrophonium blocks acetyl-cholinesterase
    • Beware of cholinergic cardiac effects. Use with Atropine 0.6mg
  • Thoracic CT and MRI to rule out thymoma

ACh

Anti AChR Ab’s

AChR

localising the lesion
Localising the lesion
  • Monocular visual field defects indicate lesions anterior to the optic chiasm
  • Bitemporal defects are the hallmark of chiasmal lesions
  • Binocular homonymous hemianopia result from lesions in the contralateral postchiasmal region
  • Binocular quadrantanopias reflect optic tract lesions