Download MBBS Ophthalmology PPT 13 Ocular Present Cns Diseases Lecture Notes

Ocular Presentation in Diseases

of central Nervous system

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INTRODUCTION

Intracranial lesions may cause:

-serious ocular signs and symptoms

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-neurological complications (raised ICT)

-cranial nerve impairment or brain compression

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INTRODUCTION

Intracranial lesions may cause:

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-serious ocular signs and symptoms

-neurological complications (raised ICT)

-cranial nerve impairment or brain compression

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>50 % - present to an ophthalmologist

initially

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INTRODUCTION

Intracranial lesions may cause:

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-serious ocular signs and symptoms

-neurological complications (raised ICT)

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-cranial nerve impairment or brain compression

>50 % - present to an ophthalmologist

initially

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Ophthalmologists play a vital role in

early diagnosis and proper referral.

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HOW DO THE PATIENT PRESENT ?

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CLINICAL PRESENTATION

SYMPTOMS:
? Headache
? Diminution of Vision

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? Seizures
? Behavioural and psychiatric changes
? Vertigo
? Paresis
? Dysphasia, dementia, deafness, tinnitus, ataxia,

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and diplopia etc.
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CLINICAL PRESENTATION
SIGNS (one or more of following depending upon location and size)

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? Vision
? Visual field defects
? Proptosis
? Pupillary defect

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? Papilloedema
? Optic atrophy

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CLINICAL PRESENTATION

SIGNS:
? Nystagmus
? Gaze palsy

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? Paralytic squint [Cranial Nerve palsies-VI, VI , IV]

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Intracranial lesions

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? MENINGITIS

? ENCEPHALITIS

INFECTIONS

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? BRAIN ABSCESS

? NEUROSYPHILIS

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Intracranial lesions

? INTRACRANIAL

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ISCHEMIC

ANEURYSMS

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AND

? CEREBRAL ISCHEMIA

CIRCULATORY

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AND HAEMORRAHGES

DISORDERS

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? HYDROCEPHALOUS

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INTRACRANIAL ANEURYSMS- 2 to 3 %

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? in the region of circle of willis
1. Congenital weakness in the wall

2. Post traumatic

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3. Post infection

? Carotico-cavernous fistula

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CEREBRAL ISCHEMIA AND HAEMORRAHGES

? Transient ischaemic attacks

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? Cerebral strokes

? Intra cerebral hematoma

? Sub arachnoid haemorrhage

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HYDROCEPHALOUS

? Congenital

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? acquired

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Intracranial lesions

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? MULTIPLE SCLEROSIS

DEMYLENATING

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? NEUROMYELITIS OPTICA

LESIONS

? SCHILDER'S DISEASE

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MULTIPLE SCLEROSIS
? Loss of sensory or motor function of different parts of body
? Optic neuritis

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? Sudden DV

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NEUROMYELITIS OPTICA

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? Bilateral Optic neuritis with Lumbar / thoracic myelitis

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SCHILDER'S DISEASE, DIFFUSE SCLEROSIS

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? OPTIC RADIATION,
? RBN,
? Muscle palsy,
? Nystagmus

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Chronic Progressive Ophthalmoplegia

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? friedreich's disease [hereditary ataxia]

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Intracranial lesions

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? CONCUSSION INJURY TO

BRAIN

HEAD INJURY

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? CEREBRAL CONTUSION

? FRACTURE BASE OF

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SKULL

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Intracranial lesions

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? PRIMARY OPTIC TUMOURS
? SECONDARY TUMOURS

ICSOLS

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? HAMETOGENOUS LESION
? GRANULOMATOUS LESION
? PARASITIC CYST

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most common types in adults ?

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? pituitary adenoma

? meningioma

? craniopharyngioma

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DIFFERENTIAL DIAGNOSIS OF ICSOL OCULAR FEATURES

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1 Frontal lobe tumours(gliomas, meningiomas) Slight bulging of eye ball (ipsilateral).If extension into chiasm -foster

kennedy syndrome ,papilloedema,optic atrophy,psychic changes,

Alteration in character and temperament

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2 Olfactory groove tumours (meningiomas)

Frontal lobe and optic nerve pushed up(simulates pituitary tumour)

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3 Sphenoidal ridge tumours (meningiomas)

Proptosis

4 Pituitary tumours (adenomas)

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Optic nerve ischemia then atrophy, Bitemporal heminopia, Colour

field defective

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5 Suprasellar (Rathke's pouch) tumours

Papilloedema, diplopia(VI nerve involvement

(craniopharyngioma)

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6 Median area tumours (Meningiomas)

Paralysis of V.VI,VII ,Homonymous hemianopia, Papilloedema

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7 Temporal lobe tumours (Gliomas,

Contralateral homonymous hemianopia(Incongruous)

meningiomas)

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8 Occipital tumours

Congruous field defects

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9 Cerebellar tumours (medulloblastoma)

Coarse horizontal nystagmus,Bilateral papilledema,diplopia(VI nerve

palsy)

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10 Cerebellopontine angle tumours (Neuromas, Paralysis of V.VI,VII

neurofibromas, or gliomas in connection

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24 wi

-03-2th a

022 coustic and vestibular nerves)

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? Extraocular disturbances.

(a) Sensory.

(b) Motor.

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(c) Psychic

(d) Endocrinal.

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HOW DO WE CLINICALLY APPROACH........

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CLINICAL APPROACH
? HISTORY......v.v important

? Presenting complaint

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? Past

? Family

? Personal habits

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? OPHTHALMOLOGICAL:

? Vision (BCVA)

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? Visual fields and colour perception

? Pupil ary reflexes

? Displacement of the eyebal .

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CLINICAL APPROACH

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? Extraocular movements(gaze

palsy, paralytic squint or

nystagmus)

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? Dilated fundus examination with IO

( papilloedema, papillitis, optic

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nerve atrophy, retinal

haemorrages, arteritis,

atherosclerotic changes ,etc..)

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HOW TO

INVESTIGATE...?

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investigations
? CBC with ESR

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BASELINE

? URINE ROUTINE AND MICROSCOPY

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Special Investigations-

? MRI brain with orbit

? CT scan

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? Fundus flurorescein angiography

? B- scan

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? VER

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investigations
And other special investigations(if needed):

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? Viral markers

? Mantoux test for Tuberculosis

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? CSF analysis

? VDRL for syphilis

? Orbital biopsy

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? FNAC of lesion

? X-Rays if needed

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? Angiography

? Doppler ultrasonography

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Summary

Detailed

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Judicious

Careful

neuro-

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use of

CORRECT

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history

ophthalmic

neuroimag

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Investigations

DIAGNOSIS and

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evaluation

ing

TREATMENT

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