Shlomo Dotan
Hadassah-Hebrew University Medical Center, Israel
Title: Neuro-ophthalmologic diagnoses you do not want to miss
Biography
Biography: Shlomo Dotan
Abstract
Aim:
The presentation will elaborate on twelve neuro-ophthalmologic disorders, part of a longer list, which can potentially cause
death or blindness if not diagnosed and treated correctly
Aneurysmal third nerve palsy. Aneurysm is not the most common compressive lesion causing third nerve palsy, but it has the
highest mortality if untreated. Giant cell arteritis is an idiopathic inflammatory vasculitis affecting small –to-medium size arteries,
which can cause blindness, but also cerebral infarction and cardiac ischemia. Myasthenia gravis is an autoimmune disease of the
neuromuscular junction, which has both an ocular and generalized form. Myasthenic crisis is a neurologic emergency, which
causes paralysis of the muscles of breathing. Pituitary apoplexy results from hemorrhagic infarction of the pituitary gland, and
causes acute endocrine and neurologic symptoms.
Pseudotumor cerebri or idiopathic intracranial hypertension is a condition of unknown cause that produces elevated intracranial
pressure and papilledema primarily in young obese females. In 24% of cases can cause visual dysfunction. Primary optic nerve
sheath meningioma is the most common tumor of the optic nerve sheath, and it typically presents with a slowly progressive optic
neuropathy characterized by a variable loss of visual acuity. Pituitary adenomas are the most common cause of chiasmal lesions
in adults. The most common symptom of a chiasmal compressive lesion is gradual, painless, progressive and bilateral vision loss.
Fungal optic neuropathy may complicate meningitis resulting from a variety of molds and yeasts. The prevalence of these
disorders increases in immunocompromised or immunosuppressed patients with diabetes, lymphoreticular disorders or AIDS.
Neuromyelitis optica or Devic disease is characterized by acute or subacute loss of vision in one or both eyes caused by acute optic
neuropathy preceded or followed within days or weeks by a transverse or ascending myelopathy. Horner syndrome is manifested
with acute neck pain and a miotic pupil. It may be caused by a lesion along the sympathetic pathway that supplies the head, eye
and neck. Toxic/nutritional optic neuropathies usually develop over months with a painless, bilateral, symmetric and progressive
loss of central vision, but some cases may present with acute and severe vision loss such as poisoning with methanol or ethylene
glycol. Transient monocular visual loss lasting minutes in an altitudinal fashion should be considered to be ischemic, due to
cardioembolic source or giant cell arteritis, until proven otherwise