A Clinical Approach to Neuro-Ophthalmic Disorders

369 Pages·2022·50.33 MB·English

by  Vivek Lal

A CLINICAL APPROACH
TO NEURO-OPHTHALMIC
DISORDERS
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
A CLINICAL APPROACH
TO NEURO-OPHTHALMIC
DISORDERS
Edited by
Vivek Lal MD (Medicine), DM (Neurology), FIAN, FRCP (Edin)
Professor and Head
Department of Neurology at PGIMER
Chandigarh, India
First edition published 2023
by CRC Press
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Library of Congress Cataloging‑in‑Publication Data
Names: Lal, Vivek, editor.
Title: A clinical approach to neuro-ophthalmic disorders / edited by Vivek Lal.
Description: First edition. | Boca Raton, FL : CRC Press, 2022. | Includes
bibliographical references and index. | Summary: “Neuro-ophthalmology is
a merged subspecialty of neurology and ophthalmology dealing with
complex multisystem diseases presenting with visual manifestations. This
book helps the reader in recognizing, approaching, and managing such a
patient”-- Provided by publisher.
Identifiers: LCCN 2022002542 (print) | LCCN 2022002543 (ebook) | ISBN
9780367030513 (hardback) | ISBN 9781032251486 (paperback) | ISBN
9780429020278 (ebook)
Subjects: MESH: Vision Disorders | Nervous System Diseases
Classification: LCC RE951 (print) | LCC RE951 (ebook) | NLM WW 140 | DDC
617.7/5--dc23/eng/20220209
LC record available at https://lccn.loc.gov/2022002542
LC ebook record available at https://lccn.loc.gov/2022002543
ISBN: 978-0-367-03051-3 (hbk)
ISBN: 978-1-032-25148-6 (pbk)
ISBN: 978-0-429-02027-8 (ebk)
DOI: 10.1201/9780429020278
Typeset in Warnock Pro
by KnowledgeWorks Global Ltd.
Access the Support Material: www.routledge.com/9781032251486
To both my Patients and Residents—they are the joy of my world.
To My Wife—Sadhna, My Children—Raghav, Parth & Gayatri
and my Retriever Biba—they are my world.
I wish my wife continuous good luck and my noble children all the
very best as they face the challenges life throws at them.
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
CONTENTS
Foreword ..............................................................................................................................................................................................................................ix
Preface ..................................................................................................................................................................................................................................xi
Acknowledgments ..........................................................................................................................................................................................................xiii
About the Editor ...............................................................................................................................................................................................................xv
Contributors ...................................................................................................................................................................................................................xvii
PART I: BASICS OF NEURO-OPHTHALMOLOGY
1. Clinical Examination in Neuro-Ophthalmology ..................................................................................................................................2
Selvakumar Ambika, Krishnakumar Padmalakshmi
2. Visual Fields in Neuro-Ophthalmology ................................................................................................................................................20
Simon J. Hickman
3A. Optical Coherence Tomography (OCT) and Fundus Fluorescein Angiography (FFA) in Neuro-Ophthalmology .............32
Ramandeep Singh, Deeksha Katoch, Mohit Dogra, Basavaraj Tigari, Simar Rajan Singh, Sahil Jain,
Bruttendu Moharana, Sabia Handa, Mangat R. Dogra
3B. Visual-Evoked Potential in Neuro-Ophthalmology ...........................................................................................................................44
Usha K. Misra
PART II: NEURO-OPHTHALMOLOGY: THE AFFERENT PATHWAY
4. Approach to “Visual Loss”........................................................................................................................................................................50
Aastha Takkar Kapila, Monika Singla, Vivek Lal
5. O ptic Neuropathies Associated with Multiple Sclerosis (MS) and Neuromyelitis Optica
Spectrum Disorders (NMO-SD) ............................................................................................................................................................67
Gordon Plant, Vivek Lal
6. Papilledema: Diagnosis and Management ............................................................................................................................................81
Prem S. Subramanian
7. Optic Neuropathies Associated with Systemic Disorders and Radiation-Induced Optic Neuropathy ..................................90
Fiona Costello
8. Infectious Optic Neuropathies................................................................................................................................................................99
Imran Rizvi, Ravindra Kumar Garg
9. Ischemic Optic Neuropathies ................................................................................................................................................................108
Amod Gupta
10. Infiltrative Optic Neuropathies ............................................................................................................................................................120
Aniruddha Agarwal, Sabia Handa, Vishali Gupta
11. Nutritional Optic Neuropathy ..............................................................................................................................................................129
William Sultan, Giulia Amore, Uchenna Francis Nwako, Stacey Aquino Cohitmingao,
Samuel Asanad, Alfredo Sadun
12. Inherited Optic Neuropathies ...............................................................................................................................................................138
Hui‑Chen Cheng, Jared Ching, An‑Guor Wang, Patrick Yu‑Wai‑Man
13. Non-Organic Vision Loss .......................................................................................................................................................................147
Ashwini Kini, Mangayarkarasi Thandampallayam Ajjeya, Padmaja Sudhakar
PART III: NEURO-OPHTHALMOLOGY: THE EFFERENT PATHWAY
14. An Approach to Pupillary Disorders: Physiology and Pathology ..................................................................................................158
Sarosh M. Katrak, Azad M. Irani
15A. Ocular Motor Cranial Neuropathies ...................................................................................................................................................163
Zane Foster, Ashwini Kini, Bayan Al‑Othman, Andrew G. Lee
15B. Neuromuscular Junction Syndromes and Ocular Myopathies......................................................................................................170
Dan Milea
15C. Orbital Inflammatory Syndromes ........................................................................................................................................................178
Jaspreet Sukhija, Savleen Kaur
vii
viii Contents
15D. Congenital Cranial Dysinnervation Disorder ...................................................................................................................................185
Ramesh Kekunnaya, Mayank Jain
16. Infection-Associated Ocular Cranial Nerve Palsies ........................................................................................................................193
Hardeep Singh Malhotra, Imran Rizvi, Neeraj Kumar, Kiran Preet Malhotra, Gaurav Kumar,
Manoj K. Goyal, Manish Modi, Ravindra Kumar Garg, Vivek Lal
PART IV: HIGHER VISUAL PATHWAYS
17. An Approach to a Patient with Gaze Disorder ..................................................................................................................................210
P. Vinny Wilson
18. A Clinical Approach to Abnormal Eye Movements .........................................................................................................................221
M. Madhusudanan
19A. Special Considerations in Gaze: Physiology and Disorders of Saccade Velocity .......................................................................232
Mohamed Elkasaby, Aasef G. Shaikh
19B. Special Considerations in Gaze: Disorders of Gaze Holding .........................................................................................................241
Neel Fotedar, Aasef G. Shaikh
20. Cortical Visual Loss .................................................................................................................................................................................249
Jason J.S. Barton
PART V: SPECIAL CONSIDERATIONS IN NEURO-OPHTHALMOLOGY
21A. An Approach to Visual Loss in a Child ...............................................................................................................................................270
Muhammad Hassaan Ali, Stacy L. Pineles
21B. An Approach to Oculomotor Anomalies in a Child ........................................................................................................................278
Stacy L. Pineles
22. Radiological Interpretation in Neuro-Ophthalmology ..................................................................................................................286
Chirag Kamal Ahuja, Paramjeet Singh
23. Neuro-Ophthalmological Findings in Patients with Posterior Circulation Stroke .................................................................306
Louis R. Caplan
24. Toxins in Neuro-Ophthalmology .........................................................................................................................................................314
Varun K. Singh, Usha K. Misra
25. Neuropathology of Neuro-Ophthalmic Disorders ...........................................................................................................................321
Bishan Radotra
Answers to Case Studies ...............................................................................................................................................................................................335
Index ..................................................................................................................................................................................................................................337
FOREWORD
When I was approached to write a Foreword for A Clinical Upon reading through the chapters, it is apparent that this
Approach to Neuro‑Ophthalmic Disorders, edited by my old fusion of the relevant parts of these two specialties relevant
friend Professor Vivek Lal, I was intrigued to see how this vastly to clinical neuro-ophthalmology has been extremely well
experienced clinical neuro-ophthalmologist and educator would addressed. The text is firmly based on the clinical approach to
apply his experience to conceiving and executing such a manual, the patient with neuro-ophthalmological problems, but it also
with a team of eminent Indian and international experts. Clinical provides essential background knowledge that is fundamental
neuro-ophthalmology, one of the sub-specialties in clinical medi- to clinical practice. Of particular value to the trainee neuro-
cine which spans major disciplines, in this case neurology and ophthalmologist is the first chapter of each section, providing
ophthalmology, is as a consequence often perceived as a difficult a well-considered clinical approach to the patient presenting
clinical subject. This is especially so since most practitioners with with specific neuro-ophthalmological symptoms, for example,
an interest migrate to the subject either from a purely neurologi- visual loss, gaze disorder. There are also a couple of very useful
cal or ophthalmological training. To successfully achieve exper- chapters on clinical approaches to dealing with pediatric neuro-
tise in the subject requires considerable knowledge and practical ophthalmological problems.
skills in both, as well as a good knowledge of neuro-anatomy All in all, this textbook is very clearly written and is to be highly
and neurophysiology. For example, the examination of the fun- recommended for those who want to learn more about assess-
dus, which is routinely achieved by the neurologist using a direct ing and treating patients with clinical neuro-ophthalmological
ophthalmoscope now needs to be supplemented by the ophthal- problems.
mologist’s direct ophthalmoscopy using a slit lamp and ocular
coherence tomography to fully appreciate ongoing pathological Christopher Kennard
processes affecting the fundus and optic nerve axons. Professor Emeritus in Clinical Neurology
University of Oxford
ix