Important notes by the doctor

Neuro-ophthalmic diseases

Optic disc = blind spot ( yellowish orange ) Normal cup:disc ratio is 0.4 Optic nerve is surrounded by sheath of dura mater , pia mater , arachnoid ( the meninges )

Papilledema : optic disc swelling secondary to increase ICP . Caused by anything that increase ICP 1- space occupying lesion : tumor 60% ,hydocephalus , hemorrhage . 2- inflammatory : meningitis 3- drugs : steroid 4- malignant HTN

Clinical pic : Headache , vision is not always affected ( may be blurred . Chronic papilledema cause optic disc atrophy because of decrease blood supply due to edema .

RAPD Seen in : 1- extensive retinal disease ( RAO ,RVO , maculopathy ) 2- optic nerve disease (ON , AION ) Cataract doesn’t cause RAPD . RAPD : a medical sign observed during swinging flash light test , where the patient’s pupils constrict less ( appearing to dilate ) when bright light is swung from normal eye to affevted eye .. Wiki

Optic neuritis Many causes associated with MS . F:M =2:1 , age 20-45 Is demylinating inflammation of optic nerve . Types : 1- papillitis (10%) : if optic nerve head is affected , more in children, disc swelling . 2- retrobulbar (90%) : when nerve is affected posteriorly , more in young , disc swelling is not seen .

1- sudden significant blurring in vision 2- change in color perception ( dyschromatopsia ) 3- change in light saturation 4- RAPD : if optic nerve is affected until geniculate body , if posterior to that RAPD is not seen 5- central scotoma 6- pain on ocular movement : because medial and superior recti are attached to meninges sheath of optic nerve .

-Investigation : MRI -TT : IV steroid for 3 days Oral steroid for 11 days Then tapering

AION Internal carotid artery – ophthalmic artery – short ciliary ( anterior ) – central retinal artery 1- non-arteric (90%) : due to ischemia in ant. Ciliary artery circulation . Etiology : HTN , atherosclerosis , DM Clinical pic : 1-altitudinal defect : combination of a relative inferior altitudinal defect and absolute inferior nasal defect ( most common ) 2-Sudden painless loss of vision on wakening 3-Poor visual acuity Management : investigation + internal consultation

TT : admission and IV steroid 2- arteric (10%) : Ex. Giant cell arteritis ( skip lesion ) : ( Jaw claudication , temporal headache , loss of pulsation ) Investigation : biopsy of artery +ve in 90-95% but maybe false –ve due to skip lesion . TT : admission and IV steroid

Idiopathic intracranial HTN ( IIH) Aka : pseudotumor cerecbri , benign intracranial HTN Is increase ICP with no lesion in brain ( papilledema ) Dx by exclusion Risk factors : 1- overweight 2- fair , female (90%) , at child bearing age 3- OCP Clinical pic : Headache , diplopia , transient visual obstruction , dizziness, nausea and vomiting , photopsia , retrobulbar pain , pulse ( synchromous tinnitus ) TT : 1- weight reduction 2- remove any precipitating factor if possible 3- acetazolamide 4- if not useful VP shunt