Neuro-ophthalmology: the practical guide

513 Pages·2005·120.15 MB·English

by  Levin, Leonard A., Arnold, Anthony C

N -O
EURO PHTHALMOLOGY
T P G
HE RACTICAL UIDE

N -O
EURO PHTHALMOLOGY
T P G
HE RACTICAL UIDE
Leonard A. Levin, M.D., Ph.D.
Associate Professor of Ophthalmology and Visual Sciences,
Neurology, and Neurological Surgery
University of Wisconsin Medical School
Madison, Wisconsin
Anthony C. Arnold. M.D.
Professor and Chief, Neuro-Ophthalmology Division
Jules Stein Eye Institute
Department of Ophthalmology
University of California at Los Angeles
Los Angeles, California
Thieme
New York Stuttgart
(cid:1)
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Library of Congress Cataloging-in-Publication Data
Neuro-ophthalmology: the practical guide/[edited by] Leonard A. Levin, Anthony C. Arnold.
p. ; cm.
Includes index. (cid:1)
ISBN 1-58890-183-1 (alk.(cid:1)paper) ISBN 3-13-138311-9 (alk. pap(cid:1)er) 1. Neuroophthalmology.
/
[DNLM: 1. Eye Diseases diagnosis. 2. Cranial(cid:1)Nerve Diseases diagnosis.
/ /
3. Eye Manifestations. 4. Optic Nerve Diseases diagnosis. WW 140 N494 2005]
/
I. Levin, Leonard A. II. Arnold, Anthony C.
RE725.N(cid:1)47 2005
617.7’32 dc22
/
2004019079
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D
EDICATION
To Daniel M. Jacobson (1956(cid:1)2003): insightful neuro-ophthalmologist;
/
patient teacher; valued friend.

C
ONTENTS
FOREWORD ix
PREFACE xi
ACKNOWLEDGMENTS xiii
CONTRIBUTORS xv
SECTION I. THE NEURO-OPHTHALM*IC EXAMINATION
1. Clinical Testing of Visual Function Guruswami Arunagiri and Robert C. Sergott 3
* /
2. Pupil Testing Preston C. Calvert 11
/ *
3. Techniques of the Oculomotor Examination Francine B. Wein and Wayne T.
/
Cornblath 17
*
4. Choice and Interpretation of Visual Field Testing Michael Wall 21
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SECTION II. NEURO-OP*HTHALMIC SYMPTOMS AND SIGNS
5. Transient Visual Loss Bradley J. Katz 37
*/
6. Persistent Visual Loss Leonard A. Levin and Anthony C. Arnold 46
* /
7. Visual Field Defects Andrew G. Lee and Paul W. Brazis 58
/ *
8. Positive Visual Phenomena Howard D. Pomeranz 68
* /
9. Diplopia and Polyopia Andrew G. Lee and Paul W. Brazis 74
* /
10. Nystagmus Eric R. Eggenberger 85
/ *
11. Optic Disc Edema Richard E. Appen 101
* /
12. Optic Disc Pallor Judith E. A. Warner 113
/ *
13. Ocular and Orbital Pain Paul W. Brazis and Andrew G. Lee 127
* /
14. Proptosis Lynn K. Gordon 145
*/
15. Anisocoria Aki Kawasaki 156
/ *
16. Ptosis and Lagophthalmos Robert A. Egan 167
/
SECTION III. NEURO-OP*HTHALMIC DIAGNOSES
17. Pseudotumor Cerebri Deborah I. Friedman 183
/ *
18. Arteritic Anterior Ischemic Optic Neuropathy Norah S. Lincoff 187
/
vii
viii . CONTENTS
*
19. Nonarteritic Anterior Ischemic Optic Neuropathy Sophia M. Chung 194
* /
20. Idiopathic Optic Neuritis Leonard A. Levin and Anthony C. Arnold 198
/ *
21. Other Inflammatory Optic Neuropathies Larry P. Frohman 202
* /
22. Compressive Optic Neuropathy Christopher Anthony Girkin 217
/ *
23. Congenital Optic Nerve Anomalies Karl C. Golnik 222
* /
24. Hereditary Optic Neuropathy Martha P. Schatz 231
/ *
25. Toxic and Metabolic Optic Neuropathies Valerie Ann Purvin 238
* /
26. Traumatic Optic Neuropathy Richard M. Rubin 246
* /
27. Optic Nerve Tumors Neil R. Miller 253
/*
28. Diseases of the Chiasm Francine B. Wein 263
/ *
29. Diseases of the Retrochiasmal Visual Pathways Joel M. Weinstein 267
* /
30. Third Nerve Palsies Francine B. Wein 281
*/
31. Fourth Nerve Palsies Jacqueline A. Leavitt 285
* /
32. Sixth Nerve Palsies Lyn Alice Sedwick 292
/ *
33. Cavernous Sinus Disorders Misha L. Pless 296
/ *
34. Myasthenia Gravis and Ocular Myopathies Steven R. Hamilton 304
* /
35. Supranuclear Disorders of Eye Movement Mark J. Morrow 310
* /
36. Horner’s Syndrome Hadas Stiebel-Kalish 318
* /
37. Adie’s Pupil Randy H. Kardon and Oliver Bergamin 325
/ *
38. Thyroid-Associated Orbitopathy (Graves’ Disease) Francine B. Wein 340
* /
39. Orbital Tumors Swaraj Bose 345
/ *
40. Orbital Inflammation and Infection R. Nick Hogan 356
* /
41. Migraines and Migraine Variants Marie D. Acierno and James J. Corbett 387
* /
42. Facial Nerve Disorders Rod Foroozan and Mark L. Moster 392
/*
43. Thromboembolic Disease Thomas R. Hedges III 400
* /
44. Nonorganic Visual Loss Mark S. Borchert 407
/
SECTION IV. NEURO-OPHTHALMIC*PROCEDURES
45. Neuro-Ophthalmic Emergencies Vale´rie Biousse and Nancy J. Newman 414
/ *
46. Ancillary Electrophysiologic Testing David I. Kaufman 422
* /
47. Temporal Artery Biopsy Parna S. Shenoy and Barrett Katz 438
* /
48. Lumbar Puncture Lenworth N. Johnson and Michael A. Meyer 442
* /
49. Neuroimaging Lanning B. Kline, Deepak Takhtani, and Joel K. Cure´ 445
/ *
50. Billing for Neuro-Ophthalmologic Diseases Michael X. Repka 459
/
INDEX 465
F
OREWORD
Neuro-ophthalmology remains the clinical dis- under-utilized. Practitioners would obviously
cipline quintessentially concerned with and benefit if there were a text from which they
dependent on the elucidation of diagnoses by could gain the assistance necessary to appro-
the analysis of symptoms and signs. While the priately evaluate and manage patients with
neuro-ophthalmologist makes judicious use of neuro-ophthalmic presentations.
special tests as indicated, they play a secondary Theavailabletextsdevotedtoneuro-ophthal-
role and are usually reserved for confirmation mology, several of which are outstanding in
and to help direct therapy. By contrast, in many their own right, are primarily directed to the
other branches of clinical medicine the history neuro-ophthalmologist and ophthalmologist
and physical examination, once the bulwarks of and are not readily accessible to physicians
our profession, have become subordinated to outside of these fields. Levin and Arnold’s
technology. Yet patients with neurological and Neuro-Ophthalmology: The Practical Guide, how-
systemic disorders that are heralded or accom- ever, is meant precisely for all clinicians who
panied by disordered vision or ocular motility are typically responsible for initial evaluation
rarely present initially to a neuro-ophthalmolo- of patients with neuro-ophthalmic presenta-
gist.Thepractitionersfromwhompatientswith tions. This book redresses all of the deficiencies
neuro-ophthalmic symptoms and signs first previously enumerated; it is a complete source
seek help may be unprepared by training and in a format congenial to the needs of those
experience to fully meet the challenge. Since physicians. The reader is led through a discus-
these physicians are hampered by a limited sion of testing, and an analysis of symptoms
capacity for differential diagnosis the implica- and signs, and an explication of neuro-ophthal-
tions and significance of the problems with mic diseases and their management and is
which they are confronted may go unrecog- guided through the use of special testing. The
nized.Determiningwhetherapatient’sproblem liberaluseoflistsisoneoftheexcellentfeatures
represents an emergency, quite difficult in some of this text.
situations, demands an appreciation of the The editors and the authors have produced a
nuances. Some physicians do not know when readable, authoritative and, above all, practical
to refer or what will be done if the patient is guide for the perplexed.
referred. Experience has shown that referral
and special testing tends to be both over- and
Simmons Lessell, M.D.
Harvard University
ix