Neuro-ophthalmology Question of the Week-Optic Neuropathies

Question:
Which of the following statements are correct?
1. Anterior ischemic optic neuropathies are considered the equivalent of a “stroke of the optic nerve”.
2. The causes and mechanisms of anterior ischemic optic neuropathies and stroke are different.
3. The workup of a patient with an ischemic optic neuropathy is not the same as that for patients with retinal or cerebral infarction.
4. The clinician’s primary role in ischemic optic neuropathies is to exclude giant cell arteritis, control vascular risk factors, treat anemia, and prevent hypotension (e.g., in the setting of dialysis).
5. Anterior ischemic optic neuropathies are not associated with ipsilateral internal carotid artery stenosis and embolic AION is extremely rare.
6. Medications, such as amiodarone, may induce an optic neuropathy often indistinguishable from AION.
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Neuro-ophthalmology Questions of the Week: Optic Neuropathies

Questions:
1. What is the most common optic neuropathy in patients over age 50?
2. Why are altitudinal visual field defects common in ischemic optic neuropathies?
3. Do emboli commonly cause ischemic optic neuropathy?

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Neuro-ophthalmology Question of the Week: Secondary Demyelinating Processes & Optic Neuritis

Questions:
1. When inflammatory optic neuritis is not associated with a primary demyelinating process in the optic nerve or the central nervous system what is the likely cause?
2. When inflammatory optic neuritis is not associated with a primary demyelinating process in the optic nerve or the central nervous system what should drive the work-up?
3. Is optic neuritis common in secondary and tertiary syphilis?
4. How is syphilitic optic neuritis treated and what is its prognosis?
5. What should be done all patients with HIV and optic neuritis?
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Neuro-ophthalmology Question of the Week-Acute Disseminated Encephalomyelitis (ADEM)

Questions:
1. Is ADEM more common in in children or adults?
2. What may the clinical symptoms and MRI changes of ADEM mimic?
3. How many symptomatic episodes of ADEM is a patient likely to experience?
4. Is optic neuritis seen in some patients with ADEM?
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Neuro-ophthalmology Questions of the Week-Neuromyelitis Optica (Devic Disease)

Questions:
1. Does the Transverse myelopathy of Neuromyelitis Optica (NMO) precede or follow the onset of optic neuritis?
2. Is there an antibody test for NMO?
3. What is the prognosis for NMO?
4. What are the diagnostic criteria for NMO?
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Neuro-ophthalmology Questions of the Week: Idiopathic Demyelinating Optic Neuritis

Questions:
1. What is the most common acute optic neuropathy in persons under the age of 45?   
2. What is the most common cause of optic neuritis?
3. What condition is a common presenting sign of multiple sclerosis?

Neuro-ophthalmology Questions of the Week: Inflammatory Optic Neuropathy

Questions:

1. What historical factors are important to assess in a patient with suspected optic neuropathy?

2. What tests should be considered based on the assessment of appropriate historical factors?

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Neuro-ophthalmology Questions of the Week-Optic Neuropathy Patient Evaluation

Questions:

1. Are some maculopathies associated with mild optic nerve pallor?
2. Can maculopathies have dyschromatopsia?
3. In evaluating optic neuritis, when should a lumbar puncture for CSF analysis be considered?


Fig.8.5
(a) Isolated right inflammatory optic neuropathy. There is a large central scotoma seen as diffuse depression on a 24–2 Humphrey visual field test.
(b)Coronal and axial T1-weighted magnetic resonance imaging with fat suppression and contrast showing enhancement of the orbital portion of the right optic nerve(arrow).

Neuro-ophthalmology Question of the Week: Optic Neuropathies Introduction

Question:
1. In acute optic neuropathy, how long after onset does the optic nerve head become pale?
2. When is electrophysiologic testing useful in acute optic neuropathies?
3. What does a painful orbital apex syndrome in a diabetic patient suggest?

Fig.8.1

Neuro-ophthalmology Question of the Week: Optic Tract Defects

Question:
Which of the following are correct for a left optic tract lesion?
1. Right homonymous hemianopia
2. Left RAPD
3. Bowtie atrophy of the right optic nerve
4. Mostly temporal pallor of the left optic nerve

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