NEURO OPHTHALMOLOGY Powerpoint Presentation

NEURO OPHTHALMOLOGY

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Slide 1 :

NEURO-OPHTHALMOLOGY

Slide 2 :

Clinical Examination Visual Acuity Colour Vision Visual Fields Pupils

Slide 3 :

Normal Eye and Optic Disc Cupped disc

Slide 4 :

The swollen optic disc Papilloedema Papillitis Malignant hypertension Ischaemic optic neuropathy Diabetic optic neuropathy CRVO Intraocular inflammation

Slide 5 :

25 y.o. female Reduced VA Pain with eye movement Colour desaturation RAPD

Slide 6 :

65 y.o. male Reduced VA Painless loss of vision Essential hypertension Smoker

Slide 7 :

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

Slide 8 :

Papilloedema 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 CWS Blurred optic disc margin Small optic cup Disc pallor Vessel attenuation

Slide 9 :

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)

Slide 10 :

Pupil Constricted (mioisis) Sympathetic (pupillodilator) denervation Drugs Pilocarpine Morphine Dilated (mydriasis) Parasympathetic (pupilloconstrictor) denervation Lesion of the third CN Drugs Atropine Cocaine

Slide 11 :

Slide 12 :

Horner’s Oculosympathetic paresis Ptosis Miosis Ipsilateral anhidrosis Does not dilate with cocaine 4%

Slide 13 :

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)

Slide 14 :

Pancoast bronchogenic carcinoma Otitis Media Tolosa-Hunt Sy. CVA Tumour Internal Carotid Dissection Herpes Zoster

Slide 15 :

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.

Slide 16 :

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

Slide 17 :

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

Slide 18 :

Cranial Nerve Palsies Looking straight ahead

Slide 19 :

Posterior communicating artery aneurysm III CN Posterior cerebral artery Chiasma

Slide 20 :

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

Slide 21 :

Myasthenia Gravis Fatigability Double vision Lid twitch Ptosis Normal reflexes & sensation

Slide 22 :

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 Anti AChR Ab’s AChR ACh

Slide 23 :

Slide 24 :

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

Slide 25 :

mhmd on Sep 24, 2009 Says :

clear & simple presentaion on neuorophthalmology

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Myasthenia Gravis. Fatigability; Double vision; Lid twitch; Ptosis; Normal reflexes & sensation. IN more Myasthenia Gravis. Fatigability; Double vision; Lid twitch; Ptosis; Normal reflexes & sensation. INVESTIGATIONS MG. Anti ACh receptor Ab’s; Electromyography … less