A Day of Cases
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Advice for Floaters and Flashing Lights for Primary Care
UK Vision Strategy RCGP – Royal College of General Practitioners Advice for Floaters and Flashing Lights for primary care Key learning points • Floaters and flashing lights usually signify age-related liquefaction of the vitreous gel and its separation from the retina. • Although most people sometimes see floaters in their vision, abrupt onset of floaters and / or flashing lights usually indicates acute vitreous gel detachment from the posterior retina (PVD). • Posterior vitreous detachment is associated with retinal tear in a minority of cases. Untreated retinal tear may lead to retinal detachment (RD) which may result in permanent vision loss. • All sudden onset floaters and / or flashing lights should be referred for retinal examination. • The differential diagnosis of floaters and flashing lights includes vitreous haemorrhage, inflammatory eye disease and very rarely, malignancy. Vitreous anatomy, ageing and retinal tears • The vitreous is a water-based gel containing collagen that fills the space behind the crystalline lens. • Degeneration of the collagen gel scaffold occurs throughout life and attachment to the retina loosens. The collagen fibrils coalesce, the vitreous becomes increasingly liquefied and gel opacities and fluid vitreous pockets throw shadows on to the retina resulting in perception of floaters. • As the gel collapses and shrinks, it exerts traction on peripheral retina. This may cause flashing lights to be seen (‘photopsia’ is the sensation of light in the absence of an external light stimulus). • Eventually, the vitreous separates from the posterior retina. Supported by Why is this important? • Acute PVD may cause retinal tear in some patients because of traction on the retina especially at the equator of the eye where the retina is thinner. -
Supranuclear and Internuclear Ocular Motility Disorders
CHAPTER 19 Supranuclear and Internuclear Ocular Motility Disorders David S. Zee and David Newman-Toker OCULAR MOTOR SYNDROMES CAUSED BY LESIONS IN OCULAR MOTOR SYNDROMES CAUSED BY LESIONS OF THE MEDULLA THE SUPERIOR COLLICULUS Wallenberg’s Syndrome (Lateral Medullary Infarction) OCULAR MOTOR SYNDROMES CAUSED BY LESIONS OF Syndrome of the Anterior Inferior Cerebellar Artery THE THALAMUS Skew Deviation and the Ocular Tilt Reaction OCULAR MOTOR ABNORMALITIES AND DISEASES OF THE OCULAR MOTOR SYNDROMES CAUSED BY LESIONS IN BASAL GANGLIA THE CEREBELLUM Parkinson’s Disease Location of Lesions and Their Manifestations Huntington’s Disease Etiologies Other Diseases of Basal Ganglia OCULAR MOTOR SYNDROMES CAUSED BY LESIONS IN OCULAR MOTOR SYNDROMES CAUSED BY LESIONS IN THE PONS THE CEREBRAL HEMISPHERES Lesions of the Internuclear System: Internuclear Acute Lesions Ophthalmoplegia Persistent Deficits Caused by Large Unilateral Lesions Lesions of the Abducens Nucleus Focal Lesions Lesions of the Paramedian Pontine Reticular Formation Ocular Motor Apraxia Combined Unilateral Conjugate Gaze Palsy and Internuclear Abnormal Eye Movements and Dementia Ophthalmoplegia (One-and-a-Half Syndrome) Ocular Motor Manifestations of Seizures Slow Saccades from Pontine Lesions Eye Movements in Stupor and Coma Saccadic Oscillations from Pontine Lesions OCULAR MOTOR DYSFUNCTION AND MULTIPLE OCULAR MOTOR SYNDROMES CAUSED BY LESIONS IN SCLEROSIS THE MESENCEPHALON OCULAR MOTOR MANIFESTATIONS OF SOME METABOLIC Sites and Manifestations of Lesions DISORDERS Neurologic Disorders that Primarily Affect the Mesencephalon EFFECTS OF DRUGS ON EYE MOVEMENTS In this chapter, we survey clinicopathologic correlations proach, although we also discuss certain metabolic, infec- for supranuclear ocular motor disorders. The presentation tious, degenerative, and inflammatory diseases in which su- follows the schema of the 1999 text by Leigh and Zee (1), pranuclear and internuclear disorders of eye movements are and the material in this chapter is intended to complement prominent. -
Retina and Neuro Ophthalmology
Name : …………………………………………………………… Roll No. : ………………………………………………………… Invigilator's Signature : ……………………………………….. CS/B.OPTM/SEM-5/BO-504/2010-11 2010-11 OCULAR DISEASE - II POSTERIOR SEGMENT ( RETINA & NEURO-OPHTHALMOLOGY ) Time Allotted : 3 Hours Full Marks : 70 The figures in the margin indicate full marks. Candidates are required to give their answers in their own words as far as practicable. GROUP – A ( Multiple Choice Type Questions ) 1. Choose the correct alternatives for any ten of the following : 10 × 1 = 10 i) Which is not an important diagnostic criterion of giant cell arteritis ? http://www.makaut.com/ a) ESR > 70 mm/hour b) C-reactive protein > 2·45 mg/dl c) Jaw caludication d) Neck pain. ii) Unilateral blindness in a male child with massive exudation under the retina is most likely a case of a) Coat's disease b) Retinoblastoma c) Sturge-Weber syndrome d) Louis-Bar's syndrome. 5323 [ Turn over http://www.makaut.com/ CS/B.OPTM/SEM-5/BO-504/2010-11 iii) A retinal detachment patient mostly complains of a) pain b) good vision c) flashes and floaters d) diplopia. iv) In myasthenia gravis, during a diagnostic test, we use a drug called a) Piperazine citrate b) Azathioprim c) Edrophonium d) Carbamazepine. v) Sillicone oil is a/an a) aqueous substitute b) lens substitute c) vitreous substitute d) artificial lens. vi) In retinoblastoma, if the microscopical examination shows Flexner-Wintersteiner rosettes, it is considered to be a) highly malignant b) less malignant c) not malignant d) none of these. vii) Dyschromatopsia is the term for defective a) day vision b) night vision http://www.makaut.com/ c) colour vision d) light brightness sensitivity. -
A Case of Multiple Sclerosis Presenting As Eight and Half Syndrome
Online Journal of Health and Allied Sciences Peer Reviewed, Open Access, Free Online Journal Published Quarterly : Mangalore, South India : ISSN 0972-5997 This work is licensed under a Volume 11, Issue 4; Oct-Dec 2012 Creative Commons Attribution- No Derivative Works 2.5 India License Case Report: A Case of Multiple Sclerosis Presenting as Eight and Half Syndrome. Authors Rajiv Raina, Professor, Madan Kaushik, Assistant Professor, Sanjay K Mahajan, Assistant Professor, Sushil Raghav, Senior Resident, Sharathbabu NM, Junior Resident, Dept. of Medicine, Indira Gandhi Medical College, Shimla. Address for Correspondence Dr. Sharathbabu NM, Junior Resident, Dept. of Medicine, Indira Gandhi Medical College, Shimla, India. E-mail: [email protected] Citation Raina R, Kaushik M, Mahajan SK, Raghav S, Sharathbabu NM. A Case of Multiple Sclerosis Presenting as Eight and Half Syndrome. Online J Health Allied Scs. 2012;11(4):15. Available at URL: http://www.ojhas.org/issue44/2012-4-15.html Open Access Archives http://cogprints.org/view/subjects/OJHAS.html http://openmed.nic.in/view/subjects/ojhas.html Submitted: Dec 5, 2012; Accepted: Jan 7, 2013; Published: Jan 25, 2013 Abstract: Multiple sclerosis (MS) is a chronic disease spinal cord. MRI showed hyperintensities on T2 weighted characterized by inflammation, demyelination, gliosis images oriented perpendicular to the ventricular surface, (scarring), and neuronal loss; the course can be relapsing- corresponding to the pathologic pattern of perivenous remitting or progressive. Manifestations of MS vary from a demyelination (Dawson's fingers) and hyperintensities in the benign illness to a rapidly evolving and incapacitating dorsal tegmentum of caudal pons(Fig. 3a & 3b). Patient was disease requiring profound lifestyle adjustments. -
NEUROLOGY in TABLE.Pdf
ZAPORIZHZHIA STATE MEDICAL UNIVERSITY DEPARTMENT OF NEUROLOGY DISEASES NEUROLOGY IN TABLE (General neurology) for practical employments to the students of the IV course of medical faculty Zaporizhzhia, 2015 2 It is approved on meeting of the Central methodical advice Zaporozhye state medical university (the protocol № 6, 20.05.2015) and is recommended for use in scholastic process. Authors: doctor of the medical sciences, professor Kozyolkin O.A. candidate of the medical sciences, assistant professor Vizir I.V. candidate of the medical sciences, assistant professor Sikorskaya M.V. Kozyolkin O. A. Neurology in table (General neurology) : for practical employments to the students of the IV course of medical faculty / O. A. Kozyolkin, I. V. Vizir, M. V. Sikorskaya. – Zaporizhzhia : [ZSMU], 2015. – 94 p. 3 CONTENTS 1. Sensitive function …………………………………………………………………….4 2. Reflex-motor function of the nervous system. Syndromes of movement disorders ……………………………………………………………………………….10 3. The extrapyramidal system and syndromes of its lesion …………………………...21 4. The cerebellum and it’s pathology ………………………………………………….27 5. Pathology of vegetative nervous system ……………………………………………34 6. Cranial nerves and syndromes of its lesion …………………………………………44 7. The brain cortex. Disturbances of higher cerebral function ………………………..65 8. Disturbances of consciousness ……………………………………………………...71 9. Cerebrospinal fluid. Meningealand hypertensive syndromes ………………………75 10. Additional methods in neurology ………………………………………………….82 STUDY DESING PATIENT BY A PHYSICIAN NEUROLOGIST -
Eyes and Stroke: the Visual Aspects of Cerebrovascular Disease
Open Access Review Stroke Vasc Neurol: first published as 10.1136/svn-2017-000079 on 6 July 2017. Downloaded from Eyes and stroke: the visual aspects of cerebrovascular disease John H Pula,1 Carlen A Yuen2 To cite: Pula JH, Yuen CA. Eyes ABSTRACT to the LGBs,1 5 6 the terminal anastomosis is and stroke: the visual aspects of A large portion of the central nervous system is dedicated vulnerable to ischaemia.7 Optic radiations cerebrovascular disease. Stroke to vision and therefore strokes have a high likelihood 2017; : originate from the lateral geniculate nucleus and Vascular Neurology 2 of involving vision in some way. Vision loss can be the e000079. doi:10.1136/svn- (LGN) and are divided into superior, inferior, 2017-000079 most disabling residual effect after a cerebral infarction. and central nerve fibres. The optic radiations Transient vision problems can likewise be a harbinger of are predominantly supplied by the posterior stroke and prompt evaluation after recognition of visual and middle cerebral arteries1 and the AChA.6 Received 12 March 2017 symptoms can prevent future vascular injury. In this review, Inferior fibres, known as Meyer’s Loop,6 travel Revised 30 May 2017 we discuss the visual aspects of stroke. First, anatomy and Accepted 2 June 2017 the vascular supply of the visual system are considered. to the temporal lobe, while the superior and Published Online First Then, the different stroke syndromes which involve vision central nerve fibre bundles travel to the pari- 6 July 2017 1 are discussed. Finally, topics involving the assessment, etal lobes. The termination of optic radia- prognosis, treatment and therapeutic intervention of vision- tions is located in the visual striate cortex (V1) specific stroke topics are reviewed. -
GAZE and AUTONOMIC INNERVATION DISORDERS Eye64 (1)
GAZE AND AUTONOMIC INNERVATION DISORDERS Eye64 (1) Gaze and Autonomic Innervation Disorders Last updated: May 9, 2019 PUPILLARY SYNDROMES ......................................................................................................................... 1 ANISOCORIA .......................................................................................................................................... 1 Benign / Non-neurologic Anisocoria ............................................................................................... 1 Ocular Parasympathetic Syndrome, Preganglionic .......................................................................... 1 Ocular Parasympathetic Syndrome, Postganglionic ........................................................................ 2 Horner Syndrome ............................................................................................................................. 2 Etiology of Horner syndrome ................................................................................................ 2 Localizing Tests .................................................................................................................... 2 Diagnosis ............................................................................................................................... 3 Flow diagram for workup of anisocoria ........................................................................................... 3 LIGHT-NEAR DISSOCIATION ................................................................................................................. -
Conjoint Ophthalmology Scientific Conference (COSC 2017)
Artwork for the 7th Conjoint Ophthalmology Scientific Conference (COSC 2017) Logo COSC 2017 (designed by Dr Aliff Irwan Cheong) The logo symbolizes: 1. “C” represents as the whole eye, and its fluidic and wave like angle shape, exhibit the conference main theme “Angles and Curves”. The inferior tail of the “C” crosses and twist towards the word 2017 represents the conference aim in achieving advancement in Ophthalmology especially in Malaysia. 2. “O” represents the cornea and pupil – exhibit the specialty of interest : Glaucoma & Cornea. 3. “7” signify in RED is a hallmark of conference by COSC 2017. 4. BLUE – Theme color for conference and shown with the year its being held 5. BLACK – Second theme color for conference and shown in the other structure of interest Front Cover Artwork (designed by Dr Tan Li Mun) 1. Image of Cornea and Kuala Lumpur City Centre (KLCC) - Signifies the theme of our conjoint "Angles and Curves" and the location of our event held in Kuala Lumpur 2. Image of Pupil and Iris on the background - Signifies the other parts of anterior segment of the eye. ii Foreword The 7th Conjoint Ophthalmology Scientific Conference (COSC 2017) was held on 15-17 September 2017 at the Pullman Kuala Lumpur Bangsar, Kuala Lumpur. These Scientific Conferences have been held by the Malaysian Universities Conjoint Committee of Ophthalmology every year since 2011, and the theme for this year‟s meeting was „Angles and Curves - New Perspectives on Glaucoma and Cornea Management‟. The programme consisted of workshops, lectures and case discussions conducted by expert international and local speakers, and updated participants on latest developments in the two exciting fields. -
Juxtaposition of One and a Half Syndrome with Pseudo One and a Half Syndrome
Case Report Annals of Clinical Case Reports Published: 11 Dec, 2018 Juxtaposition of One and a Half Syndrome with Pseudo One and a Half Syndrome Edward Chai, Sirac Cardoza*, Ivan Rosado, Prabjhot Manes, Haidy Rivero and Adam Bernstein Department of Neurology, The Brooklyn Hospital Center, USA Abstract Conjugate gaze palsy with contralateral internuclear ophthalmoplegia or One and a Half Syndrome, is a rare neurological condition that was originally described in 1967. The authors present two patients, one with true one and a half syndrome caused by a CVA and another with pseudo one and a half syndrome caused by myasthenia gravis. Clinical presentation of these syndromes can be similar with minute differences appreciated on physical exam; however, the clinical relevance is quite large as the management is entirely different. Abbreviations INO: Internuclear Ophthalmoplegia; MLF: Medial Longitudinal Fasciculus; PPRF: Para Median Pontine Reticular Formation; CT: Computed Tomography; MRI: Magnetic Resonance Imaging Introduction “One and a half syndrome” was originally described in 1967 as conjugate gaze palsy with a contralateral Internuclear Ophthalmoplegia (INO) [1]. The syndrome is typically due to a single unilateral lesion of the Paramedian Pontine Reticular Formation (PPRF) or the abducens nucleus, and the adjacent Medial Longitudinal Fasciculus (MLF) [2,3]. Damage to the former manifests as the ipsilateral conjugate gaze palsy. Damage to the latter interrupts the internuclear fibers crossing midline to the contralateral medial rectus resulting in contralateral adduction failure on opposite gaze [2]. The side of the INO refers to the direction in which the previous adductor palsy manifests and is contralateral to the gaze palsy. -
The One-And-A-Half Syndrome. Clinical Correlation with a Pontine Lesion Demonstrated by Nuclear Magnetic Resonance Imaging in a Case of Multiple Sclerosis
Br J Ophthalmol: first published as 10.1136/bjo.72.7.515 on 1 July 1988. Downloaded from British Journal of Ophthalmology, 1988, 72, 515-517 The one-and-a-half syndrome. Clinical correlation with a pontine lesion demonstrated by nuclear magnetic resonance imaging in a case of multiple sclerosis C N MARTYN AND D KEAN From the University Departments of Medicine and Radiology, Royal Infirmary, Edinburgh SUMMARY Nuclear magnetic resonance (NMR) imaging has been used to visualise a localised area of demyelination in the dorsal pons of a patient who presented with an unusual disorder of eye movements, namely, the one-and-a-half syndrome. Judged clinically the patient made a nearly complete recovery, but little change was apparent in the NMR image six months later. The unusual and remarkable disorder of eye move- eye movements in response to head turning. A ment consisting of a lateral gaze palsy in one direction contralateral internuclear ophthalmoplegia was and an internuclear ophthalmoplegia in the other was present: the left eye failed to adduct past the midline, probably first described by Freeman et al. and later and horizontal jerking nystagmus was apparent in the dubbed the one-and-a-half syndrome by Fisher.2 In abducting right eye. Up-gaze was incomplete with the fully developed syndrome one eye is in the gaze-evoked upbeat nystagmus, and convergence midline and completely fails to move horizontally was impaired. Figs. 1-3 illustrate the horizontal gaze while the other can only abduct. Fisher attributed the palsies. There was an incomplete left-sided facial syndrome to a single unilateral lesion affecting the palsy of lower motor neurone type, and taste http://bjo.bmj.com/ centre for conjugate lateral gaze in the paramedian sensation was lost on the left side of the tongue. -
The Neuro-Ophthalmology of Cerebrovascular Disease*
The Neuro-Ophthalmology of Cerebrovascular Disease* JOHN W. HARBISON, M.D. Associate Professor, Department of Neurology, Medical College of Virginia, Health Sciences Division of Virginia Commonwealth University, Richmond The neuro-ophthalmology of cerebrovascular however, are important pieces to the puzzle the disease is a vast plain of neuro-ophthalmic vistas, patient may present. A wide variety of afflictions encompassing virtually all areas of disturbances of of the eye occur by virtue of its arterial dependence the eye-brain mechanism. This paper will be re on the internal carotid artery. It is also logical to stricted to those areas of the neuro-ophthalmology assume that changes in the distribution of the of cerebrovascular disease which one might con ophthalmic artery may reflect changes taking place sider advances in its clinical diagnosis and treatment. in other channels of the internal carotid artery Most practitioners of medical and surgical neu the middle cerebral, the anterior cerebral, and de rology give little thought to that aspect of medicine pending upon anatomic variations, the posterior generally accepted as the ideal approach to any cerebral artery. This paper will discuss these afflic disease-prevention. Usually when one is presented tions, those common as well as rare, those well with an illness of the central nervous system, it recognized, and those frequently overlooked. seems to be a fait accompli. Although prevention Historically, the recognition of the eye as an is by no means new, certain aspects of it qualify index of cerebrovascular disease presents an inter as advances. There is one advance in cerebrovascu rupted course. Virchow is credited with the first lar disease in which prevention plays a significant autopsy correlation of ipsilateral blindness with role. -
Home>>Common Retinal & Ophthalmic Disorders
Common Retinal & Ophthalmic Disorders Cataract Central Serous Retinopathy Cystoid Macular Edema (Retinal Swelling) Diabetic Retinopathy Floaters Glaucoma Macular degeneration Macular Hole Macular Pucker - Epiretinal Membrane Neovascular Glaucoma Nevi and Pigmented Lesions of the Choroid Posterior Vitreous Detachment Proliferative Vitreoretinopathy (PVR) Retinal Tear and Detachment Retinal Artery and Vein Occlusion Retinitis Uveitis (Ocular Inflammation) White Dot Syndromes Anatomy and Function of the Eye (Short course in physiology of vision) Cataract Overview Any lack of clarity in the natural lens of the eye is called a cataract. In time, all of us develop cataracts. One experiences blurred vision in one or both eyes – and this cloudiness cannot be corrected with glasses or contact lens. Cataracts are frequent in seniors and can variably disturb reading and driving. Figure 1: Mature cataract: complete opacification of the lens. Cause Most cataracts are age-related. Diabetes is the most common predisposing condition. Excessive sun exposure also contributes to lens opacity. Less frequent causes include trauma, drugs (eg, systemic steroids), birth defects, neonatal infection and genetic/metabolic abnormalities. Natural History Age-related cataracts generally progress slowly. There is no known eye-drop, vitamin or drug to retard or reverse the condition. Treatment Surgery is the only option. Eye surgeons will perform cataract extraction when there is a functional deficit – some impairment of lifestyle of concern to the patient. Central Serous Retinopathy (CSR) Overview Central serous retinopathy is a condition in which a blister of clear fluid collects beneath the macula to cause acute visual blurring and distortion (Figure 2). Central serous retinochoroidopathy Left: Accumulation of clear fluid beneath the retina.