By Valerie A. Purvin
Utilizing real-life instances describing sufferers with neuro-ophthalmic issues, this publication is a case-based educating software that bridges the space among textbook details and daily medical perform. every one case illustrates a specific quarter of widespread diagnostic confusion, and highlights the categorical scientific beneficial properties that are meant to element to the right kind prognosis. targeting blunders during this manner serves as motivation to the clinician to grasp the cloth in order that 'pitfalls' will be refrained from. the extent of the case discussions assumes that the reader has a few familiarity with simple neuroanatomy, body structure and sickness technique yet each one case dialogue furnishes a short overview of such info, consistently with an emphasis on these gains which are clinically correct. The case-histories are succinct and amply illustrated, together with motility and fundus images, visible fields and radiographic experiences. The narrative is moved besides inquiries to the reader, making it effortless to persist with the common sense of the instances.
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Additional resources for Common Neuro-Ophthalmic Pitfalls: Case-Based Teaching
Painless vertical diplopia What clinical features help to localize the source of this patient’s ocular motility disorder? Case: This 62-year-old engineer had a one-year history of painless vertical diplopia that remained undiagnosed despite a variety of neurodiagnostic tests. After some initial progression he felt that his double vision had remained stable. His medical history was unremarkable except for wellcontrolled hypertension. 9A). Infraduction was full and saccadic velocities were normal, as was the remainder of the The normal saccadic velocity in the face of marked limitation of eye movement speaks strongly against supranuclear or cranial nerve dysfunction and points instead to either myasthenia or orbital restrictive disease (see Chapter 7, Farmer with an adduction deficit).
The ERG is uniformly abnormal in CAR syndrome, usually showing loss of a- and b-waveforms under photopic and scotopic conditions. Even when central acuity is relatively preserved, the ERG may be surprisingly flat. While the electrophysiologic abnormalities in CAR are indistinguishable from those of some hereditary retinal dystrophies, the more rapid progression and older age at onset are features favoring a diagnosis of CAR syndrome. As in the above case, the normal fundus appearance and fluorescein angiogram create the impression of neurologic visual loss.
Dalmau, Neuro-ophthalmology and paraneoplastic syndromes. Curr Opin Neurol, 17 (2004), 3–8. D. M. Jacobson, H. D. Pomeranz, Paraneoplastic diseases of neuro-ophthalmic interest. In N. R. Miller, N. J. Newman, V. Biousse, J. B. , Walsh and Hoyt’s Clinical Neuro-Ophthalmology, 6th edn. Philadelphia: Lippincott Williams and Wilkins, 2005, Vol. 2, Chapter 36, pp. 1715– 58. R. A. Sawyer, J. B. Selhorst, L. E. Zimmerman, W. F. Hoyt, Blindness caused by photoreceptor degeneration as a remote effect of cancer.
Common Neuro-Ophthalmic Pitfalls: Case-Based Teaching by Valerie A. Purvin