The Sankara Nethralaya Atlas of Neuro-Ophthalmology Satya Karna, Ambika S, Padmaja S, Smita Menon, Nikhil S Choudhari
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1The Sankara Nethralaya: Atlas of Neuro-Ophthalmology2
3The Sankara Nethralaya: Atlas of Neuro-Ophthalmology
Second Edition
Satya Karna DNB Ex-Associate Consultant, Neuro-ophthalmology Ambika S DNB Consultant, Neuro-ophthalmology Padmaja S DNB Consultant, Neuro-ophthalmology Smita Menon MS, FRCS (Glas.) Ex-Associate Consultant, Oculoplasty Nikhil S. Choudhari DNB Associate Consultant, Glaucoma and Neuro-ophthalmology Reviewed by Lingam Gopal FRCS (Edin) Chairman, Sankara Nethralaya
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Atlas of Neuro-Ophthalmology
© 2007, Sankara Nethralaya
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition: 2003
Second Edition: 2007
9788184481198
Typeset at JPBMP typesetting unit
Printed at Ajanta Press
5Foreword to the First Edition
Many neurological disorders are reflected in the eyes and the speciality of neuro-ophthalmology lies at the confluence of two major disciplines of medicine – ophthalmology and neurology.
Ophthalmology is not just a visual science of the eyes allowing us to visualize the world around us. The diagnosis and management of ophthalmic disorders is complex and is dependant on imaging of the eye and brain using sophisticated instrumentation. This atlas encompasses diagnostic radiology and clinical neuro-ophthalmology and hence is a highly effective teaching tool.
The purpose of this atlas is to provide ophthalmologists and other physicians concerned with eye disease with a carefully selected collection of quality illustrations that review the spectrum of diseases commonly seen in neuro-ophthalmic practice.
I am sure that the Atlas of Neuro-Ophthalmology that is based on experience with patients seen at Sankara Nethralaya will play a key role in acquainting the ophthalmologist with neuro-ophthalmic disorders. The photographs are augmented by succinct textual descriptions and useful references that allow deeper investigation into the subject. It is for these reasons that this book may be recommended to all students and practitioners of ophthalmology. I congratulate the authors for their hard work in producing this atlas.
Dr SS Badrinath frcs(c)
Chairman
Medical Research Foundation
Sankara Nethralaya
Chennai, India
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7Preface to the Second Edition
The information explosion in neuro-ophthalmology since the first edition motivated us to plan for this edition. The aim was to make this edition current and comprehensive. Hence we have updated the Atlas with 335 new photographs, 9 new chapters and the latest references for further reading. We have added a special section on illustrative multiple choice questions with explanatory answers. We have organized and edited many of the existing chapters. The new chapters include diabetic papillopathy, Leber's hereditary optic neuropathy, normal tension glaucoma, blepharospasm and hemifacial spasm, orbital apex syndrome, skew deviation, HIV and neuro-ophthalmic disorders, cerebral venous thrombosis and orbital varices. We trust that this edition will be used frequently in the day-to-day practice of ophthalmologists, radiologists, neurologists, neurosurgeons and neuro-ophthalmologists worldwide.
Authors
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9Preface to the First Edition
The last 25 years have seen an explosion in neuroimaging technology paralleling the growth in information technology. The last decade has seen neuro-ophthalmology grow into a rich and complex field of study. There are very few atlases of neuro-ophthalmology available to ophthalmologists worldwide and to my knowledge, none from Asia. Our goal in writing this book is to provide an overview of the diseases that constitute neuro-ophthalmology, with pictorial assistance. This atlas is a guide to the interpretation of clinical symptoms and signs in neuro-ophthalmology.
Each section is color coded and the chapters in each section are in alphabetical order for easy cross-referencing and navigation through the book. For every topic, a small number of recent classic reviews have been added. Original images of patients seen in the neuro-ophthalmology department of Sankara Nethralaya constitute this atlas. Selected disorders are illustrated using several different images that present the early and late stages of the condition as well as variations of presentation. I hope that the readers, including neurologists, neurosurgeons and radiologists, apart from ophthalmologists, will benefit from this collection and this text will serve as a useful reference to provide better care for patients. Both students and practitioners are urged to take full advantage of the wealth of outstanding textbooks on neuro-ophthalmology, the Bible of course, being Walsh and Hoyt's Clinical Neuro-Ophthalmology.
Satya Karna dnb
10Acknowledgements
We are very grateful to our Chairman Dr. S.S. Badrinath for his constant encouragement to bring out the best in us. We have been greatly influenced by Dr. Lingam Gopal's teachings and his intellect. Dr. Navin Jayakumar stimulated our interest in neuro-ophthalmology and gave us valuable advice to fine tune the book. Dr. Tarun Sharma took time to review the manuscript and gave us constructive criticism. Mr. Ramakrishnan made corrections and gave many helpful suggestions.
Special thanks are due to Dr. Veena Noronha who guided us to choose the best neuroimaging pictures for this book. S.P. Govindarajan, Chidambaram and Santhanam of the medical photographic department carefully took most of these photographs and this book would not have been possible without them. V. Murali and his team of Sukumar, Shankar and Mohan of the multimedia department have scanned and archived the pictures in record time. Credit goes to all the patients who enriched our experience and learning by putting their faith in us and allowing us to record these pictures. We appreciate the secretarial assistance of Beena who helped us archive the images on a regular basis.
We are extremely grateful to all the consultants of Sankara Nethralaya and Dr Deepak Arjundas (Neurologist), Dr Suresh Bapu (Neurosurgeon) and Dr B Chidambaram (Pediatric Neurosurgeon) among other specialists who helped us in the comprehensive management of these cases.
We wish to express our gratitude to Professor Mrs. Nirmala Subramaniam, Dr. Malay Verma, Dr. Bhaskar Srinivasan, Dr. Murali Krishna and Dr. Smriti Chaudhary for their valuable contribution to the second edition of this Atlas.
Our friends and families have supported us and given us extremely useful ideas to improve the book.
This atlas represents Sankara Nethralaya's experience in the practice of clinical neuro-ophthalmology.
Finally, the efforts and cooperation of Jaypee Brothers Medical Publishers (P) Ltd. are gratefully acknowledged.