Neuro-Ophthalmology

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Optic Nerve
Bilateral papilledema in a young woman with pseudotumor cerebri. Note the small retinal ripples, Paton's lines (white arrowheads) and nerve fiber hemorrhage (yellow arrowhead) in the right eye.

  • A syndrome that is defined by:
    • Papilledema occurs in over 90% of patients
    • Elevated intracranial pressure with normal CSF composition
    • Normal neuroimaging studies
    • Normal neurologic exam
    • Occurs primarily in young obese females
  • Clinical features:
    • Most common symptom is headache.
    • Other symptoms include normal or uncommonly decrease visual acuity, transient obscurations of vision, photopsias, diplopia, nausea, vomiting, pulsatile tinnitus and visual field loss secondary to optic disc swelling
    • Signs:
      • Bilateral optic disc edema
      • May have abducens nerve palsy
  • Work up:
    • Complete ophthalmological and neurological examinations including visual acuity, color vision, pupillary reactivity, fundus examination and visual field study of patients with papilledema
    • Neuroimaging study and lumbar puncture
    • Fundus photographs are also important to monitor disc swelling
  • Management:
    • Depends on visual status and whether or not the associating cause can be identified or treated
    • Treatment of underlying causes
    • Weight-loss program for obese patients
    • Cessation of substances causing PTC, such as vitamin A, tetracycline, etc.

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