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Manual of Neuro-ophthalmology
Amar Agarwal, Athiya Agarwal
1:
Supranuclear Pathways for Eye Movements
INTRODUCTION
SUPRANUCLEAR AND INFRANUCLEAR PATHWAYS
SUPRANUCLEAR EYE MOVEMENT SYSTEMS
SACCADIC SYSTEM
Horizontal Saccades
Vertical Saccades
Characteristic of the Saccade
PURSUIT SYSTEM
Horizontal Pursuit System Pathway
Corrective Saccade
Parietal Lobe Lesion
Vertical Pursuit System
VERGENCE SYSTEM
Voluntary Vergence
Pursuit or Reflex Vergence
NON-OPTIC REFLEX SYSTEM
Semicircular Canals
Neck Receptors
Cerebellum
POSITION MAINTENANCE SYSTEM
SUMMARY
2:
Supranuclear Disorders of Eye Movements
INTRODUCTION
PSEUDO-OPHTHALMOPLEGIA
CLASSIFICATION
SACCADIC DISORDERS
CONJUGATE PALSIES
Lesions of the Frontal Cortex
Overactivity
Unilateral Underactivity
Bilateral Underactivity
Lesions of the Basal Ganglia
Overactivity
Underactivity: Progressive Supranuclear Palsy
Lesions of the Collicular Area
Parinaud's Syndrome
DISSOCIATED PALSIES
Internuclear Ophthalmoplegia
Introduction
Etiology
Classification
One and One-Half Syndrome
Dissociated Vertical Palsies
PURSUIT DISORDERS
Overactivity
Underactivity
VERGENCE DISORDERS
Paralysis of Convergence
Paralysis of Divergence
NON-OPTIC REFLEX SYSTEM DISORDERS
Vestibular System Disorders
Cerebellar Disorder
3:
Nystagmus
DEFINITION
GENERAL CONSIDERATIONS
TERMINOLOGY
Pendular Nystagmus
Jerky Nystagmus
Micronystagmus
Null Zone
Neutral Zone
Alexander's Law
GRADES
EXAMINATION OF A CASE OF NYSTAGMUS
CLASSIFICATION
OCULAR NYSTAGMUS
Deviational Nystagmus
Optokinetic Nystagmus
Introduction
Clinical Test
Kestenbaum's Newspaper Method
Barrie's Ruler Test
Optokinetic Nystagmus Drum
Pathway
Parietal Lobe Lesion
Type of OKN Abnormalities
Inverse OKN
Pathological Ocular Nystagmus
Amaurotic Nystagmus
Amblyopic Nystagmus
Spasmus Nutans
Miner's Nystagmus
Latent Nystagmus
VESTIBULAR NYSTAGMUS
Vestibular Apparatus
Caloric Test
Vertical Vestibular Nystagmus
Lesions
Canal Paresis (Peripheral Lesion)
Directional Preponderance (Central Lesion)
Rotational Nystagmus
Doll's Head Phenomenon
CEREBELLAR NYSTAGMUS
CENTRAL NYSTAGMUS
MISCELLANEOUS
Voluntary Nystagmus
Hysterical Nystagmus
Idiopathic Congenital Nystagmus
Nystagmus Blockage Syndrome
SYMPTOMS
TREATMENT
4:
The Pupil
NORMAL PUPIL
PUPILLARY PATHWAYS
Introduction
Pupilloconstrictor Light Reflex Pathway
Afferent
Efferent
Functions of the Light Reflex
Convergence Near Reflex Pathway
Afferent
Efferent
Accommodation Reflex Pathway
Afferent
Efferent
Pupillary Dilatation Pathway
Darkness Reflex
Psychosensory Reflex
PUPIL CYCLE TIME
LESIONS OF THE PUPIL
Amaurotic Pupil
Marcus Gunn Pupil
Swinging Flashlight Test
Grades
Lesion
Important Points
Wernicke's Hemianopic Pupil
Argyll Robertson Pupil
Lesion
Features
Light-Near Dissociation
Pseudo-Argyll Robertson Pupil
How to Test for a Pupillary Near Response
Tonic Pupil
Hutchinson's Pupil
Horner's Syndrome
Introduction
Central Horner's Syndrome
Preganglionic Horner's Syndrome
Postganglionic Horner's Syndrome
Pharmacological Tests for Horner's Syndrome
Reader's Syndrome
PHARMACOLOGY OF THE PUPIL
PUPIL ABNORMALITIES
Hippus
Paradoxical Pupillary Reaction
Irregularity of the Pupil
Polycoria
5:
Visual Pathway
INTRODUCTION
Retina
Optic Nerve
Optic Chiasma
Definition
Dimensions
Types
Anatomy
Relations
Optic Tract
Definition
Course
Relations
Roots
Terminations
Lateral Geniculate Body
Definition
Shape
Situation
Development
Parts
Relations
Superior Brachium
Optic Radiations
Definition
Course
Meyer's Loop
Further Course
Other Fibers
The Visual Cortex
Calcarine Sulcus
Cuneus
Histology of the Visual Cortex
Parastriate Cortex
Peristriate Cortex
LOCALIZATION IN THE VISUAL PATHWAY
Retina
Optic Nerve
Optic Chiasma
The Nasal Fibers
The Temporal Fibers
The Macular Fibers
Optic Tract
Lateral Geniculate Body
Optic Radiation
Visual Cortex
BLOOD SUPPLY OF THE VISUAL PATHWAY
Introduction
Retina
Optic Nerve
Optic Chiasma
Optic Tract
Lateral Geniculate Body
Optic Radiations
Visual Cortex
LESIONS OF THE VISUAL PATHWAY AND FIELD DEFECTS
Optic Nerve Type Field Defects
Papillomacular Bundle
Arcuate Nerve Fiber Bundle
Nasal Nerve Fiber Bundle Defects
Optic Chiasma Lesions
Bitemporal Hemianopia
Central Bitemporal Hemianopia
Junctional Scotoma
Upper Temporal Quadrantic Defects
Lower Temporal Quadrantic Defects
Optic Tract Lesions
Lateral Geniculate Body Lesions
Optic Radiations and Visual Cortex Lesions
Temporal Lobe Lesions
Parietal Lobe Lesions
Occipital Lobe Lesions
6:
Anatomy of the Optic Nerve
INTRODUCTION
COURSE
Intracranial Portion
Intracanalicular Portion
Intraorbital Portion
Intraocular Portion
RELATIONS
Intracranial Portion
Intracanalicular Portion
Intraorbital Portion
Intraocular Portion
Surface Nerve Fiber Layer
Prelaminar Region
Lamina Cribrosa
Retrolaminar Region
BLOOD SUPPLY OF THE OPTIC NERVE
Intracranial Part
Intracanalicular Part
Intraorbital Part
Intraocular Part
7:
Oculomotor Nerve
INTRODUCTION
NUCLEUS
EXIT FROM THE BRAIN
CAVERNOUS SINUS
COURSE IN SUPERIOR ORBITAL FISSURE
Definition
Size
Shape
Limbs
Borders
Relations
Common Tendinous Ring
Contents
COURSE IN THE ORBIT
CILIARY GANGLION
Introduction
Size
Color
Shape
Roots
Long or Sensory Root
Short or Motor Root
Sympathetic Root
Branches
Short Ciliary Nerve
BLOOD SUPPLY
8:
Lesions of the Oculomotor Nerve
ETIOLOGY
GENETICS
CLINICAL FEATURES
NUCLEAR THIRD NERVE PARESIS
THIRD NERVE FASCICLE SYNDROMES
Nothnagel's Syndrome
Benedict's Syndrome
Claude's Syndrome
Weber's Syndrome
UNCAL HERNIATION SYNDROME
POSTERIOR COMMUNICATING ARTERY ANEURYSM
CAVERNOUS SINUS SYNDROME
ORBITAL SYNDROME
PUPIL-SPARING ISOLATED THIRD NERVE PARESIS
ABERRANT REGENERATION OF OCULOMOTOR NERVE
MANAGEMENT
Occlusion
Medical Treatment
Surgical Treatment
9:
Trochlear Nerve and its Lesions
INTRODUCTION
NUCLEUS
COURSE
Exit from the Nucleus
Exit from the Brain
Cavernous Sinus
Superior Orbital Fissure
Orbital Course
LESIONS OF THE TROCHLEAR NERVE
Nuclear Fascicular Syndrome
Subarachnoid Space Syndrome
Cavernous Sinus Syndrome
Orbital Syndrome
Isolated Fourth Nerve Palsy
Hyperdeviation
Ocular Movements
Diplopia
Abnormal Head Posture
CHECKING FOURTH NERVE FUNCTION IN THE SETTING OF A THIRD NERVE PARESIS
BIELSCHOWSKY'S HEAD TILTING TEST
R/L Hypertropia
L/R Hypertropia
MANAGEMENT
Occlusion
Surgery
10:
Abducent Nerve and its Lesions
INTRODUCTION
NUCLEUS
EXIT FROM THE BRAIN
COURSE
Cavernous Sinus
Superior Orbital Fissure
Orbit
CLINICAL FEATURES OF SIXTH NERVE PALSY
Deviation
Ocular Movements
Diplopia
Head Posture
LESIONS
The Brainstem Syndrome
Millard-Gubler Syndrome
Raymond's Syndrome
Foville's Syndrome
Subarachnoid Space Syndrome
Petrous Apex Syndrome
Gradenigo's Syndrome
Pseudo-Gradenigo's Syndrome
Cavernous Sinus Syndrome
Orbital Syndrome
Isolated Sixth Nerve Palsy
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Occlusion
Treatment of the Cause
Surgery
Botulinum Toxin Injection
11:
Trigeminal Nerve
INTRODUCTION
NUCLEUS
EXIT FROM THE BRAIN
TRIGEMINAL CAVE
OPHTHALMIC DIVISION
Lacrimal Nerve
Frontal Nerve
Nasociliary Nerve
MAXILLARY DIVISION
MANDIBULAR DIVISION
12:
Facial Nerve and its Lesions
INTRODUCTION
NUCLEUS
The Main Motor Nucleus
Parasympathetic Nuclei
Sensory Nucleus
COURSE
LESIONS OF THE FACIAL NERVE
Supranuclear Lesion
Cerebellopontine Angle Tumor
Geniculate Ganglionitis
Isolated Ipsilateral Tear Deficiency
Lesion before Nerve to Stapedius
Lesion after Nerve to Stapedius
Lesion after Chorda Tympani Nerve
Bell's Palsy
Isolated Partial Ipsilateral Facial Palsy
SUMMARY
13:
Congenital Optic Nerve Anomalies
INTRODUCTION
CAUSES
APLASIA
HYPOPLASIA
Treatment
BERGMISTER's PAPILLAE
MYELINEATED NERVE FIBERS
OPTIC NERVE HEAD DRUSEN
COLOBOMA OF OPTIC DISK
Optic Disk Coloboma in Association with Retinochoroidal Coloboma
Coloboma of the Optic Nerve Entrance
MORNING GLORY SYNDROME
Treatment
TILTED DISK
OPTIC DISK PIT
14:
Optic Nerve Tumors
INTRODUCTION
OPTIC NERVE GLIOMAS
Clinical Features
Age
Sex
Location
Presenting Signs and Symptoms
Association with Neurofibromatosis
Radiographic Findings
Histopathology
Gross Appearance
Microscopic Findings
Management
MALIGNANT GLIOMAS OF THE OPTIC NERVE
Clinical Features
Radiology
Pathology
Prognosis
OPTIC NERVE MENINGIOMAS
Clinical Features
Signs and Symptoms
Radiology
Histopathology
Management
SECONDARY OPTIC NERVE TUMORS
Extension from the Eye
Blood-Borne Metastasis
Extension from the Meninges and Brain
Extension from Adjacent Structures
15:
Abnormalities of Optic Nerve Head
OPTIC ATROPHY
Clinical Features
Differential Diagnosis
Optic Neuritis
Clinical Features
Management
Optic Neuritis Treatment Trial (ONTT)
PAPILLEDEMA
Clinical Features
Management
ARTERITIC ANTERIOR ISCHEMIC OPTIC NEUROPATHY (AAION)
Etiology
Classic Signs
Symptoms
Differential Diagnosis
Work—up
Risk Factors
Management
Pharmacology
POSTERIOR ISCHEMIC OPTIC NEUROPATHY (PION)
16:
Ocular Myopathies
INTRODUCTION
CLINICAL FEATURES
CHRONIC PROGRESSIVE EXTERNAL OPHTHALMOPLEGIA
Kearns-Sayre Syndrome
Treatment
MYOTONIC DYSTROPHY
ESSENTIAL BLEPHAROSPASM
17:
Miscellaneous
INTRODUCTION
CRANIOPHARYNGIOMA
INTRODUCTION
History
Classification
Migraine
Symptoms and Signs
Classification of Migraine Based on Clinical Presentation
INTERNATIONAL HEADACHE SOCIETY
Criteria for Migraine Without Aura
Diagnosis
Treatment
Tension Headache
Criteria for Episodic Tension Headache
Treatment
Cluster Headache
Criteria for Cluster Headache
Treatment
Headache and Ocular Diseases
The Differential Diagnosis of Headache Disorders
INTRODUCTION
Clinical Presentation
Tests for Functional and Simulated Defects
Tests for Simulation of Uniocular Blindness
Tests for Simulated Abnormal Visual Field
Differential Diagnosis
Management
INTRODUCTION
Intracranial Aneurysms
Subarachnoid Hemorrhage
Diagnosis
Management
Carotid-Cavernous Fistula
Mechanism of Direct CCF
Causes of Glaucoma in CCF
Differential Diagnosis of CCF
Management
Indications for Treatment
CONCLUSION
18:
Examination of a Neuro-ophthalmology Case
HISTORY
Past History
Examination
Color Vision – by Pseudo-Ishihara's Chart
Pupil Examination
DIRECT LIGHT REFLEX
INDIRECT LIGHT REFLEX
SWINGING FLASH LIGHT TEST
NEAR REFLEX
Confrontation Visual Fields
Ocular Movements
Diplopia Charting
Hess Charting
Nystagmus
Fundus Examination
Visual Fields
Other Cranial Nerve Examination
First Cranial Nerve
Second Cranial nerve
Third, Fourth and Sixth Cranial Nerves
Fifth Cranial Nerve
Seventh Cranial Nerve
Eighth Cranial Nerve
Ninth and Tenth Cranial Nerves
Eleventh Cranial Nerve
Twelfth Cranial Nerve
CNS Examination
Reflexes
Coordination
Sensation
19:
Imaging in Neuro-ophthalmology
COMPUTED TOMOGRAPHY
Principles
Contrast Medium
MRI Basic Physical and Technical Principles of Relaxation, Special Sequences
Restrictions
Claustrophobia, Sedation, Surveillance
Optic Pathway Pathology
CONGENITAL PATHOLOGY OF OPTIC PATHWAYS
Infantile Presentations
Micro-ophthalmos/Anophthalmos
Ocular Tumors
Spasmus Nutans
Other White Matter Disorders
Septo-optic Dysplasia
Optic Nerve Hypoplasia
Periventricular Leukomalacia
Multiple Sclerosis
Acute Disseminated Encephalomyelitis
Trauma (Nonaccidental Injury)
Neurofibromatosis Type 1
Neurofibromatosis Type 2
INTRACRANIAL PATHOLOGY OF THE VISUAL PATHWAY
Intrinsic Lesions, Glioma in Adults
Extra-axial Tumors
Metastasis
SELLAR TUMORS
Gliomas of the Chiasm
Meningiomas
Craniopharyngioma
Astrocytomas
Pilocytic Astrocytoma (WHO I)
High Grade Glioma
Metastasis
Cavernoma (Syn. Cavernous Hemangioma) of the Cavernous Sinus
The Tolosa-Hunt syndrome
Cystic Lesions
Multiple Sclerosis
Toxoplasmosis
Acute Disseminated Encephalomyelitis (ADEM)
INDEX
TOC
Index
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