1 Copyright © 2014 Elsevier Inc. All rights reserved. Chapter 24 Neuro-ophthalmology in Medicine E.R. Eggenberger and J. Pula

2 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 24-1 A, Normal optic nerve. Note clearly visible vessels coursing over the disc edge, small central disc depression of the physiologic cup, and visible nerve fiber layer, especially in the superior and inferior arcades. B, Disc edema. Note obscurations of vessels coursing over the disc and swollen peripapillary nerve fiber layer causing disc elevation.

3 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 24-2 Optic atrophy. Note disc pallor and lack of visible nerve fiber layer striations.

4 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 24-3 Axial T1-weighted magnetic resonance imaging (MRI) demonstrating gadolinium enhancement of the left retrobulbar portion of the optic nerve (arrow).

5 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 24-4 Axial T1-weighted gadolinium-enhanced brain MRI at the level of the optic chiasm. A, Normal optic chiasm (arrow) does not enhance. B, An acute attack of neuromyelitis optica (NMO) resulting in abnormal enhancement of the optic chiasm (arrow).

6 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 24-5 Optical coherence tomography demonstrating severe optic atrophy. Note sector (green arrow) and quadrant (black arrow) maps depicting dramatic nerve fiber layer (RNFL) loss in all quadrants. The average RNFL values of 34.1 (OD) and (OS) microns indicate extreme optic atrophy (normal average RNFL ~104).

7 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 24-6 Bilateral visual field defects in sequential nonarteritic anterior ischemic optic neuropathy. The right eye demonstrates an inferior arcuate defect with “nasal step” while the left eye reveals denser inferior field defect.

8 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 24-7 Fundus photos showing papilledema. Both eyes are affected, as is typical. Features demonstrated include elevation of the retinal nerve layers, resulting in the appearance of a “doughnut”-shaped opacity around the optic disc. Peripapillary flame-shaped hemorrhages are visible, as well as engorgement of the retinal veins. Obscuration of the peripapillary blood vessels as they pass across the disc can be appreciated. The physiologic cups have disappeared.

9 Copyright © 2014 Elsevier Inc. All rights reserved. Figure 24-8 Axial T2-weighted orbital MRI from a patient with idiopathic intracranial hypertension showing bulging of the papilla (red arrows), flattening of the posterior globe (curved arrow), and intraorbital nerve tortuosity (white arrow).