Neuro-Ophthalmology and Neuro-Otology: A Case-Based Guide for Clinicians and Scientists

Preface
Acknowledgments
Contents
List of Figures
List of Tables
List of Videos\Electronic Supplemental Materials (ESM)
1: Preparing for the Exam
1.1 Equipment for the Afferent Neuro-Ophthalmology Bedside Exam
1.1.1 Vision
1.1.2 Pupils, Eyelids, Orbits
1.2 Equipment for the Efferent Neuro-Ophthalmic/Vestibular Bedside Exam
Reference
2: Disorders of the Pupils, Eyelids, and Orbits
2.1 Pupil (Tables 2.1, 2.2, and 2.3; ESM 2.1)
2.1.1 Anisocoria—The History
2.1.2 Anisocoria—The Exam
2.1.3 Pharmacologic Testing
2.1.4 Horner’s Syndrome
2.1.5 Aneursymal Third Nerve Palsy
2.1.6 Tonic Pupil
2.2 Eyelid (Ptosis and Spasm) (Tables 2.1, 2.2, and 2.3; ESM 2.1)
2.2.1 Ptosis—The History
2.2.2 Ptosis—The Exam
2.2.3 Levator Dehiscence
2.2.4 Myasthenia Gravis
2.2.5 Eyelid Spasms
2.3 Orbit/Globe
2.3.1 Orbital Disorders—The History
2.3.2 Orbital Disorders—The Exam
2.3.3 Thyroid Eye Disease
2.3.4 Eye Pain (Acute Angle Closure Glaucoma)
2.3.5 Red Eye (Carotid Cavernous Fistula)
References
3: Loss of Vision and Other Visual Symptoms
3.1 Vision Loss—The History (Tables 3.1 and 3.2; ESM 3.1)
3.2 Vision Loss—The Examination (see Chapter 1 for equipment, testing should be performed in each eye individually)
3.3 Interpretation of Monocular or Binocular Visual Fields—Dr. Neil Miller’s 10 Visual Field Rules to Live by
3.4 Ancillary Testing in Neuro-Ophthalmology
3.5 Prechiasmal (Monocular Vision Loss) Tables 3.1 and 3.2; ESM 3.1
3.5.1 Retina
3.5.1.1 Retinal TIA (Amaurosis Fugax)
3.5.1.2 Photopsias
3.5.2 Optic Nerve
3.5.2.1 NAION (nonarteritic anterior ischemic optic neuropathy)
3.5.2.2 Giant Cell Arteritis (GCA)
3.5.2.3 Optic Neuritis
3.5.2.4 Papilledema
3.6 Chiasmal Visual Disorders
3.6.1 Pituitary Tumor
3.7 Retrochiasmal Visual Disorders
3.7.1 The History
3.7.2 The Exam
3.7.3 Treatment Options
3.7.4 Optic Tract
3.7.5 Lateral Geniculate Nucleus (LGN)
3.7.6 Optic Radiations
3.7.7 Occipital Lobe/Striate Cortex
3.8 Higher Cortical Visual Disorders
3.8.1 Posterior Cortical Atrophy
3.8.2 Hallucinations
3.8.3 Visual Snow
References
4: Motility and Ocular Motor Disorders
4.1 The History
4.2 The Exam
4.3 Subarachnoid Space, Cavernous Sinus, Orbital Apex
4.3.1 Subarachnoid Space
4.3.2 Cavernous Sinus
4.3.3 Orbital Apex
4.4 Medulla
4.4.1 Lateral Medullary (Wallenberg) Syndrome (Including Skew Deviation and Saccadic Dysmetria)
4.5 Pons
4.5.1 Medial Longitudinal Fasciculus Syndrome
4.5.2 Horizontal Gaze Palsies
4.5.3 Sixth Nerve
4.6 Midbrain
4.6.1 Third Nerve
4.6.2 Fourth Nerve
4.6.3 Vertical Gaze Palsies
4.6.4 Progressive Supranuclear Palsy
4.7 Cerebellum
4.7.1 Syndrome of the Flocculus and Paraflocculus (Tonsil) Fig. 4.31
4.7.1.1 Gaze-Evoked and Rebound Nystagmus & Impaired Smooth Pursuit and Vestibulo-Ocular Reflex Suppression (VORS)
4.7.1.2 Downbeat Nystagmus
4.7.1.3 Alternating Skew Deviation
4.7.2 Syndrome of the Nodulus and Ventral Uvula Fig. 4.31
4.7.2.1 Central Patterns of Head-shaking and Periodic Alternating Nystagmus (PAN)
4.7.2.2 Positional Nystagmus
4.7.3 Syndrome of the Dorsal Vermis and Posterior Fastigial Nucleus (Figs. 4.7 and 4.8)
4.7.3.1 OMV
4.7.3.2 FOR
References
5: Oscillopsia, Nystagmus, and Other Abnormal Movements
5.1 The History—How to Approach Oscillopsia and Nystagmus
5.2 The Exam—Does My Patient Have Nystagmus or Something Else? [1]
5.3 Nystagmus
5.3.1 Horizontal Nystagmus (Bruns Nystagmus)
5.3.2 Periodic Alternating Nystagmus
5.3.3 Downbeat Nystagmus
5.3.4 Upbeat Nystagmus
5.3.5 Torsional Nystagmus
5.3.6 Oculopalatal Tremor
5.3.7 Multiple Sclerosis Acquired Pendular Nystagmus
5.4 Saccadic Intrusions, Oscillations, and Other Nystagmoid Movements (Fig. 5.1)
5.4.1 Square Wave Jerks (SWJ) and Related Saccadic Intrusions
5.4.2 Opsoclonus/Ocular Flutter
5.4.3 Superior Oblique Myokymia
References
6: Vestibular Disorders
6.1 The Vestibular History
6.1.1 TRIAGE
6.1.2 TiTrATE
6.1.3 Test (Table 6.1)
6.2 The Vestibular Examination
6.3 Bedside Auditory Testing
6.4 Laboratory Testing of Audiovestibular Disorders (Fig. 6.1, Table 6.1, ESM 6.1, 6.3, 6.4, 6.5, and 6.6)
6.5 Vestibular Syndromes
6.5.1 Acute Vestibular Syndrome (ESM 6.7)
6.5.1.1 The HINTS History
6.5.1.2 The HINTS Exam
6.5.1.3 Vestibular Neuritis
6.5.2 Episodic Vestibular Syndrome
6.5.2.1 Triggered, Episodic Vestibular Syndrome
Positional Vertigo and Nystagmus
Posterior Canal BPPV
Horizontal Canal BPPV
Central Positional Nystagmus (CPN)
Superior Canal Dehiscence Syndrome
6.5.2.2 Spontaneous, Episodic Vestibular Syndrome (ESM 6.8, 6.9)
Vestibular Migraine (VM)
Menière’s Disease (and Hearing Loss)
Vestibular Paroxysmia
Vestibular Transient Ischemia Attack (TIA)
6.5.3 Chronic Vestibular Syndrome
6.5.3.1 Persistent Postural Perceptual Dizziness
6.5.3.2 Mal de Debarquement Syndrome
6.5.3.3 Multifactorial Dizziness and Imbalance
6.5.3.4 Bilateral Vestibular Loss
References
7: Pediatric Clinical Pearls
7.1 Neuroblastoma
7.2 Neurofibromatosis Type 1 (NF-1)
7.3 Abnormal Development of the Visual Pathways (Optic Nerve Hypoplasia)
7.4 Infantile Nystagmus (IN)
7.5 Abnormal (but Characteristic) Eye Movements
7.6 Esotropia—Infantile or Acquired?
7.7 Idiopathic Intracranial Hypertension
7.8 Optic Neuritis
7.9 Myasthenia Gravis
7.10 Ocular Motor Palsies (Third, Fourth, Sixth Nerve Palsies)
7.11 Retinal Disorders Mimicking Neurologic Disease
7.12 Vertigo and Dizziness
References
Index