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Neuro-ophthalmology Questions of the Week: Idiopathic Intracranial Hypertension (IIH)

January 10, 2018 By

Questions:
1. What are the symptoms of IIH?
2. What are the criteria for the diagnosis of IIH?
3. What is the ideal test when evaluating a patient with presumed papilledema?
4. A patient with papilledema has a normal brain MRI, what test should be done next?
5. What should one consider if the headaches of IIH do not improve (at least transiently) after lumbar puncture?
6. What does a normal Brain MRI in the setting of papilledema suggest?
7. What should be evaluated next in a patient with bilateral swollen discs, normal BP, normal CT with and without contrast, LP opening pressure >250mm and normal or abnormal CSF contents?
8. What should be evaluated next in a patient with bilateral swollen discs, normal BP, normal MRI with and without contrast, LP opening pressure >250mm and normal or abnormal CSF contents?
9. What are the main factors associated with IIH?
10. What condition can cerebral venous thrombosis mimic?
11. What can early recognition of cerebral venous thrombosis prevent?
12. Should papilledema from a meningeal process or cerebral venous thrombosis be classified as IIH?
13. What are the goals of the management of IIH?
14. What is basis for management of IIH?
15. What MRI findings are supportive of the diagnosis of IIH?

Neuro-ophthalmology Question of the Week-Acute Disseminated Encephalomyelitis (ADEM)

September 6, 2017 By

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 Question of the Week: Paraneoplastic Syndromes in Neuro-Ophthalmology

August 30, 2017 By

Question: When should an ophthalmologist consider the diagnosis of a paraneoplastic syndrome?  

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Question with answers: When should an ophthalmologist consider the diagnosis of a paraneoplastic syndrome?
“In terms of afferent symptoms, an unexplained, painless, progressive vision loss is typical. With retinal involvement, there may be photopsias, night blindness, or ring scotomas. In the optic neuropathies, there is most commonly bilateral disc swelling often accompanied by vitritis. Efferent symptoms include myasthenic-like presentation or the presence of opsoclonus/myoclonus syndrome (OMS).”1

Neuro-ophthalmology Question of the Week: Magnetic Resonance Imaging

May 10, 2017 By

Question: Which of the following are correct?
1. Fat is hyperintense on T1.
2. Vitreous is hyperintense on T1.
3. CSF is hyperintense on T1.
4. Subacute blood is hyperintense on T1.
5. Fat is hypointense on T2.
6. Vitreous is hypointense on T2.
7. CSF is hypointense on T2.
8. Diffusion-weighted images are ideal in detecting acute cerebral ischemia.
9. T2 gradient echo allows better visualization of blood products, such as hemosiderin.

Neuro-ophthalmology Question of the Week: Fundus Autofluorescence

April 12, 2017 By

Question: Which of the following are hyperautofluorescent?
1. Optic Disc Drusen
2. Papilledema
3. Accumulation of lipofuscin in the retinal pigment epithelium
4. Loss of lipofuscin in the retinal pigment epithelium
5. Central serous chorioretinopathy
6. Best disease

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Neuro-ophthalmology Question of the Week: Electroretinography

April 5, 2017 By

Which of the following statements are correct?
1. Full-field ERG is useful in detecting diffuse retinal disease in the setting of generalized or peripheral vision loss.
2. The ERG is invariably severely depressed by the time patients complain of visual loss.
3. In full-field ERG the responses cannot be substantially altered voluntarily.
4. The full-field ERG may be normal in minor or localized retinal disease, particularly maculopathies, even with severe visual acuity loss.
5. Multifocal ERG is extremely helpful in detecting occult focal retinal abnormalities within the macula.
6. Uncooperative patients can alter the responses on a multifocal ERG by not fixating accurately.

Neuro-ophthalmology Question of the Week: Visual Evoked Responses

March 29, 2017 By

Question: Which of the following are correct for visual evoked responses?
1.Abnormal responses may occur if the patient does not look at the screen, does not focus on the screen, moves the tested eye, or is tired.
2. Appropriate refraction is necessary.
3. The visual evoked response reflects the integrity of the afferent visual pathway (damage anywhere from the retina to the occipital cortex may alter the signal).
4. It is primarily a function of central visual function because such a large region of the occipital cortex near the recording electrodes is devoted to macular projections.
5. Visual evoked responses are not useful in evaluating the integrity of the visual pathway in infants and inarticulate adults.
6. Visual evoked responses cannot provide an estimate of visual acuity when stimuli of various sizes are used.

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Neuro-ophthalmology Question of the Week: Bilateral Occipital Lobe Lesions & Visual Acuity

March 22, 2017 By

Question: When bilateral lesions of the retrochiasmal visual pathways produce a decrease in visual acuity which of the following are correct?
1. Such lesions produce symmetric VA loss in both eyes.
2. The VA loss from such lesions will be worse on the opposite side of the largest lesion.
3. The VA loss from such lesions will be worse on the same side of the largest lesion.
4. With the presence of retrochiasmal visual pathway lesions and different VA in the two eyes, an additional problem anterior to the chiasm must be present.

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Neuro-ophthalmology Question of the Week: Optic Tract Defects

March 15, 2017 By

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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Neuro-ophthalmology Question of the Week: Ancillary Tests

March 8, 2017 By

Questions:
1. In the photostress test, how long does the patient look at a bright light held a few centimeters from the eye?
2. In the photostress test, what is the normal recovery time to within 1 line of best corrected visual acuity? 
3. What anatomic factor explains the RAPD with an optic tract lesion?
4. What are 5 clinical settings where OKN testing may be helpful?
5. Where is the lesion likely to be located in a patient with homonymous hemianopia and asymmetric OKN response?

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