Neuro-ophthalmology sjtu ophthalmology - PowerPoint PPT Presentation

1 / 70
About This Presentation
Title:

Neuro-ophthalmology sjtu ophthalmology

Description:

Neuro-ophthalmology sjtu ophthalmology Neuro-ophthalmology an important sensory end organ intimatedly related to the brain cranial nerves: 50 II III IV ... – PowerPoint PPT presentation

Number of Views:1301
Avg rating:3.0/5.0
Slides: 71
Provided by: basicShs
Category:

less

Transcript and Presenter's Notes

Title: Neuro-ophthalmology sjtu ophthalmology


1
Neuro-ophthalmology
  • sjtu ophthalmology
  • ??

2
Neuro-ophthalmology
  • an important sensory end organ
  • intimatedly related to the brain
  • cranial nerves 50 II?III?IV?V?VI?VII
  • cranial nerve fiber 38
  • intracranial diseases 65
  • vision loss blindness die
  • diagnosis including etiology and location

3
optic neuropathy
4
structure of retina
5
nerve fiber layer
6
sensory visual pathway
7
(No Transcript)
8
anatomy of the optic nerve
  • from optic disc to optic chiasm
  • length4550mm
  • includingintraglobe 1 mm
  • intraorbit 2530 mm
  • optic canal 5 mm
  • intracrania 10 mm

9
histology of the optic nerve
  • comprised by ganglion cell axons
  • covered by meninges (3 layers)
  • lack of Schwann's cells
  • hard to rebuild

10
(No Transcript)
11
to valuate optic nerve
  • morphologyophthalmoscope ultrasonic
  • X-ray CT MRI
  • functionvision acuity visual field
  • pupil test VEPERG
  • dark adaption colour
    perception

12
visual field testing
  • steady fixation
  • measure the comdined function of the retina
  • peripheral vision
  • lt30central visual field
  • gt30peripheral visual field

13
kinetic perimetry

14
static perimetry

15
electrophysiologic testing
  • electrooculogram EOG
  • electroretinogram ERG
  • visual evoked potential VEP

16
(No Transcript)
17
pupil
18
light reflex
normal
abnormal
19
optic neuropathy
  • inflammatory
  • optic neuritis
  • vascular
  • anterior ischemic optic neuropathy (AION)
  • neoplastic infiltration
  • glioma, leukaemia, lymphoma,
  • meningeal carcinomatosis
  • others
  • optic atrophy?papilledema

20
Optic neuritis
  • duo to a variety of causes
  • the most common is demyelination
  • else immune-mediated
  • direct infections
  • granulomatous optic nueropathy
  • contiguous inflammatory disease

21
demyelinative optic neuritis
  • clinical features
  • chiefly in women(31) chiefly in white
  • associated with multiple sclerosis
  • subacute(27days)
  • color vision and contrast sensitivity
    impaired
  • pain(in eye 90)(by eye movement 50)
  • abmormal in pupil testing
  • change in VEP
  • a central scotoma in most cases
  • brain MRI (necesssary)
  • including papillitis
  • retrobulbar neuritis

22
Papillitis
  • in 35 cases
  • hyperemia of the optic disk and large veins(early
    signs)
  • edema (nearly more than 3D) (common)
  • blurring of the disk margins (common)
  • filling of the physiologic cup (common)
  • retinal exudates and edema (uncommon)
  • hemorrhage (uncommon)
  • vitreous cells (uncommon)

23
Papillitis
Fundus

24
Papillitis
25
Papillitis
CT
Visual field
26
Retrobulbar neuritis
  • vision loss
  • no obvious changes in the optic disk (at earlier
    stage)
  • secondary optic atrophy

27
demyelinative optic neuritis
  • differential diagnosis
  • compressive optic neuropathy
  • anterior ischemic optic neuropathy
  • autoimmune optic neuropathy
  • toxic amblyopia
  • Leber's hereditary optic neuropathy
  • vitamin B12 deficiency
  • papilledema

28
demyelinative optic neuritis
  • treatment
  • steroid therapy
  • can accelerate recovery of vision
  • can not influence the ultimate visual outcome
  • may increase the risk of recurrency
  • intravenous steroid therapy
  • useful for multiple sclerosis

29
anterior ischemic optic neuropathy (AION)
  • due to infarction of the retrolaminar optic
    nerve from occlusion or decreased perfusion of
    the short posterior ciliary arteries

30
vessels of the optic nerve
31
AION
  • causes
  • arteriosclerosis
  • diabetes
  • hypertension
  • hyperlipidemia
  • intracranial stroke
  • vasculitis,migraine,inherited prothrombotic
    states(in younger patients)
  • reduced cup,optic nerve head drusen,increased
    intraocular pressure

32
AION
  • clinical features
  • in the sixth or seventh decade
  • vision loss without pain
  • generally abrupt,progressive
  • altitudinal vision field defects()
  • FFAdecreased perfusion
  • segmented the
    nonarteritic form
  • diffuse the
    arteritic form
  • disk leakage the
    late phase

33
AION
34
AION
35
AION
  • treatment
  • No treatment has been shown to provide long-term
    benefit.
  • Low-dose aspirin may reduce the risk of
    involvement of the fellow eye.
  • identify the arteritic AION (high-dose systemic
    steroids)

36
Papilloedema
  • noninflammatory congestion due to raised
    intracranial pressure
  • causes
  • intracranial mass
  • abscesses
  • subdural hematoma
  • arteriovenous malformation
  • subarachnoid hemorrhage
  • meningitis or encephalitis
  • acquired hydrocephalitis
  • else

37
Papilledema
  • increased intracranial pressure
  • axonal transpot is blocked
  • edema

38
Papilledema
  • clinical features
  • normal vision in most cases for early papilledema
  • 12days to occur and 1 week to develop fully
  • severe vision loss for late papilledema

39
Papilledema
the early stage
40
papilledema
the middle stage
41
papilledema
the late stage
42
papilledema
  • FFA

43
papilledema
  • differential diagnosis
  • burid drusen of the optic nerve
  • small hyperopic disks
  • AION
  • myelinated nerve fibers

44
papilledema
  • treatment
  • deal with the underlying cause

45
Optic atrophy
  • primary optic atrophy
  • secondary optic atrophy

46
(No Transcript)
47
Optic atrophy
48
Optic atrophy
  • treatment to the underlying cause

49
optic nerve tumor
  • glioma of optic nerve
  • meningioma of optic nerve

50
Glioma of optic nerve
51
Glioma of optic nerve
52
Meningioma of optic nerve
53
Meningioma of optic nerve
54
optic nerve tumor
  • treatment operation

55
the optic chiasm

56
?????
57
(No Transcript)
58
the optic chiasm diseases
  • pituitary adenoma
  • craniopharyngioma
  • tuberculum sellae meningioma
  • chiasmatic and optic nerve gliomas

59
pituitary adenoma
60
the retrochiasmatic visual pathways
  • cortical blindness
  • macular sparing
  • macular splitting

61
(No Transcript)
62
cases
63
(No Transcript)
64
(No Transcript)
65
(No Transcript)
66
(No Transcript)
67
(No Transcript)
68
(No Transcript)
69
(No Transcript)
70
(No Transcript)
Write a Comment
User Comments (0)
About PowerShow.com