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A CLINICAL APPROACH TO NEURO-OPHTHALMIC DISORDERS Taylor & Francis Taylor & Francis Group http://taylorandfrancis.com A CLINICAL APPROACH TO NEURO-OPHTHALMIC DISORDERS Edited by Vivek Lal MD (Medicine), DM (Neurology), FIAN, FRCP (Edin) Professor and Head Department of Neurology at PGIMER Chandigarh, India First edition published 2023 by CRC Press 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742 and by CRC Press 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN CRC Press is an imprint of Taylor & Francis Group, LLC © 2023 Taylor & Francis Group, LLC This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. For works that are not available on CCC please contact [email protected] Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging‑in‑Publication Data Names: Lal, Vivek, editor. Title: A clinical approach to neuro-ophthalmic disorders / edited by Vivek Lal. Description: First edition. | Boca Raton, FL : CRC Press, 2022. | Includes bibliographical references and index. | Summary: “Neuro-ophthalmology is a merged subspecialty of neurology and ophthalmology dealing with complex multisystem diseases presenting with visual manifestations. This book helps the reader in recognizing, approaching, and managing such a patient”-- Provided by publisher. Identifiers: LCCN 2022002542 (print) | LCCN 2022002543 (ebook) | ISBN 9780367030513 (hardback) | ISBN 9781032251486 (paperback) | ISBN 9780429020278 (ebook) Subjects: MESH: Vision Disorders | Nervous System Diseases Classification: LCC RE951 (print) | LCC RE951 (ebook) | NLM WW 140 | DDC 617.7/5--dc23/eng/20220209 LC record available at https://lccn.loc.gov/2022002542 LC ebook record available at https://lccn.loc.gov/2022002543 ISBN: 978-0-367-03051-3 (hbk) ISBN: 978-1-032-25148-6 (pbk) ISBN: 978-0-429-02027-8 (ebk) DOI: 10.1201/9780429020278 Typeset in Warnock Pro by KnowledgeWorks Global Ltd. Access the Support Material: www.routledge.com/9781032251486 To both my Patients and Residents—they are the joy of my world. To My Wife—Sadhna, My Children—Raghav, Parth & Gayatri and my Retriever Biba—they are my world. I wish my wife continuous good luck and my noble children all the very best as they face the challenges life throws at them. Taylor & Francis Taylor & Francis Group http://taylorandfrancis.com CONTENTS Foreword ..............................................................................................................................................................................................................................ix Preface ..................................................................................................................................................................................................................................xi Acknowledgments ..........................................................................................................................................................................................................xiii About the Editor ...............................................................................................................................................................................................................xv Contributors ...................................................................................................................................................................................................................xvii PART I: BASICS OF NEURO-OPHTHALMOLOGY 1. Clinical Examination in Neuro-Ophthalmology ..................................................................................................................................2 Selvakumar Ambika, Krishnakumar Padmalakshmi 2. Visual Fields in Neuro-Ophthalmology ................................................................................................................................................20 Simon J. Hickman 3A. Optical Coherence Tomography (OCT) and Fundus Fluorescein Angiography (FFA) in Neuro-Ophthalmology .............32 Ramandeep Singh, Deeksha Katoch, Mohit Dogra, Basavaraj Tigari, Simar Rajan Singh, Sahil Jain, Bruttendu Moharana, Sabia Handa, Mangat R. Dogra 3B. Visual-Evoked Potential in Neuro-Ophthalmology ...........................................................................................................................44 Usha K. Misra PART II: NEURO-OPHTHALMOLOGY: THE AFFERENT PATHWAY 4. Approach to “Visual Loss”........................................................................................................................................................................50 Aastha Takkar Kapila, Monika Singla, Vivek Lal 5. O ptic Neuropathies Associated with Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorders (NMO-SD) ............................................................................................................................................................67 Gordon Plant, Vivek Lal 6. Papilledema: Diagnosis and Management ............................................................................................................................................81 Prem S. Subramanian 7. Optic Neuropathies Associated with Systemic Disorders and Radiation-Induced Optic Neuropathy ..................................90 Fiona Costello 8. Infectious Optic Neuropathies................................................................................................................................................................99 Imran Rizvi, Ravindra Kumar Garg 9. Ischemic Optic Neuropathies ................................................................................................................................................................108 Amod Gupta 10. Infiltrative Optic Neuropathies ............................................................................................................................................................120 Aniruddha Agarwal, Sabia Handa, Vishali Gupta 11. Nutritional Optic Neuropathy ..............................................................................................................................................................129 William Sultan, Giulia Amore, Uchenna Francis Nwako, Stacey Aquino Cohitmingao, Samuel Asanad, Alfredo Sadun 12. Inherited Optic Neuropathies ...............................................................................................................................................................138 Hui‑Chen Cheng, Jared Ching, An‑Guor Wang, Patrick Yu‑Wai‑Man 13. Non-Organic Vision Loss .......................................................................................................................................................................147 Ashwini Kini, Mangayarkarasi Thandampallayam Ajjeya, Padmaja Sudhakar PART III: NEURO-OPHTHALMOLOGY: THE EFFERENT PATHWAY 14. An Approach to Pupillary Disorders: Physiology and Pathology ..................................................................................................158 Sarosh M. Katrak, Azad M. Irani 15A. Ocular Motor Cranial Neuropathies ...................................................................................................................................................163 Zane Foster, Ashwini Kini, Bayan Al‑Othman, Andrew G. Lee 15B. Neuromuscular Junction Syndromes and Ocular Myopathies......................................................................................................170 Dan Milea 15C. Orbital Inflammatory Syndromes ........................................................................................................................................................178 Jaspreet Sukhija, Savleen Kaur vii viii Contents 15D. Congenital Cranial Dysinnervation Disorder ...................................................................................................................................185 Ramesh Kekunnaya, Mayank Jain 16. Infection-Associated Ocular Cranial Nerve Palsies ........................................................................................................................193 Hardeep Singh Malhotra, Imran Rizvi, Neeraj Kumar, Kiran Preet Malhotra, Gaurav Kumar, Manoj K. Goyal, Manish Modi, Ravindra Kumar Garg, Vivek Lal PART IV: HIGHER VISUAL PATHWAYS 17. An Approach to a Patient with Gaze Disorder ..................................................................................................................................210 P. Vinny Wilson 18. A Clinical Approach to Abnormal Eye Movements .........................................................................................................................221 M. Madhusudanan 19A. Special Considerations in Gaze: Physiology and Disorders of Saccade Velocity .......................................................................232 Mohamed Elkasaby, Aasef G. Shaikh 19B. Special Considerations in Gaze: Disorders of Gaze Holding .........................................................................................................241 Neel Fotedar, Aasef G. Shaikh 20. Cortical Visual Loss .................................................................................................................................................................................249 Jason J.S. Barton PART V: SPECIAL CONSIDERATIONS IN NEURO-OPHTHALMOLOGY 21A. An Approach to Visual Loss in a Child ...............................................................................................................................................270 Muhammad Hassaan Ali, Stacy L. Pineles 21B. An Approach to Oculomotor Anomalies in a Child ........................................................................................................................278 Stacy L. Pineles 22. Radiological Interpretation in Neuro-Ophthalmology ..................................................................................................................286 Chirag Kamal Ahuja, Paramjeet Singh 23. Neuro-Ophthalmological Findings in Patients with Posterior Circulation Stroke .................................................................306 Louis R. Caplan 24. Toxins in Neuro-Ophthalmology .........................................................................................................................................................314 Varun K. Singh, Usha K. Misra 25. Neuropathology of Neuro-Ophthalmic Disorders ...........................................................................................................................321 Bishan Radotra Answers to Case Studies ...............................................................................................................................................................................................335 Index ..................................................................................................................................................................................................................................337 FOREWORD When I was approached to write a Foreword for A Clinical Upon reading through the chapters, it is apparent that this Approach to Neuro‑Ophthalmic Disorders, edited by my old fusion of the relevant parts of these two specialties relevant friend Professor Vivek Lal, I was intrigued to see how this vastly to clinical neuro-ophthalmology has been extremely well experienced clinical neuro-ophthalmologist and educator would addressed. The text is firmly based on the clinical approach to apply his experience to conceiving and executing such a manual, the patient with neuro-ophthalmological problems, but it also with a team of eminent Indian and international experts. Clinical provides essential background knowledge that is fundamental neuro-ophthalmology, one of the sub-specialties in clinical medi- to clinical practice. Of particular value to the trainee neuro- cine which spans major disciplines, in this case neurology and ophthalmologist is the first chapter of each section, providing ophthalmology, is as a consequence often perceived as a difficult a well-considered clinical approach to the patient presenting clinical subject. This is especially so since most practitioners with with specific neuro-ophthalmological symptoms, for example, an interest migrate to the subject either from a purely neurologi- visual loss, gaze disorder. There are also a couple of very useful cal or ophthalmological training. To successfully achieve exper- chapters on clinical approaches to dealing with pediatric neuro- tise in the subject requires considerable knowledge and practical ophthalmological problems. skills in both, as well as a good knowledge of neuro-anatomy All in all, this textbook is very clearly written and is to be highly and neurophysiology. For example, the examination of the fun- recommended for those who want to learn more about assess- dus, which is routinely achieved by the neurologist using a direct ing and treating patients with clinical neuro-ophthalmological ophthalmoscope now needs to be supplemented by the ophthal- problems. mologist’s direct ophthalmoscopy using a slit lamp and ocular coherence tomography to fully appreciate ongoing pathological Christopher Kennard processes affecting the fundus and optic nerve axons. Professor Emeritus in Clinical Neurology University of Oxford ix