Download MBBS Ophthalmology PPT 13 Ocular Present Cns Diseases Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 13 Ocular Present Cns Diseases Lecture Notes

Ocular Presentation in Diseases

of central Nervous system

INTRODUCTION

Intracranial lesions may cause:

-serious ocular signs and symptoms

-neurological complications (raised ICT)

-cranial nerve impairment or brain compression

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INTRODUCTION

Intracranial lesions may cause:

-serious ocular signs and symptoms

-neurological complications (raised ICT)

-cranial nerve impairment or brain compression

>50 % - present to an ophthalmologist

initially

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INTRODUCTION

Intracranial lesions may cause:

-serious ocular signs and symptoms

-neurological complications (raised ICT)

-cranial nerve impairment or brain compression

>50 % - present to an ophthalmologist

initially

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

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

? Vision
? Visual field defects
? Proptosis
? Pupillary defect
? Papilloedema
? Optic atrophy

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CLINICAL PRESENTATION

SIGNS:
? Nystagmus
? Gaze palsy
? Paralytic squint [Cranial Nerve palsies-VI, VI , IV]

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Intracranial lesions

? MENINGITIS

? ENCEPHALITIS

INFECTIONS

? BRAIN ABSCESS

? NEUROSYPHILIS

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Intracranial lesions

? INTRACRANIAL

ISCHEMIC

ANEURYSMS

AND

? CEREBRAL ISCHEMIA

CIRCULATORY

AND HAEMORRAHGES

DISORDERS

? HYDROCEPHALOUS

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INTRACRANIAL ANEURYSMS- 2 to 3 %

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

2. Post traumatic

3. Post infection

? Carotico-cavernous fistula

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CEREBRAL ISCHEMIA AND HAEMORRAHGES

? Transient ischaemic attacks

? Cerebral strokes

? Intra cerebral hematoma

? Sub arachnoid haemorrhage

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HYDROCEPHALOUS

? Congenital
? acquired

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Intracranial lesions

? MULTIPLE SCLEROSIS

DEMYLENATING

? 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
? Sudden DV

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NEUROMYELITIS OPTICA

? Bilateral Optic neuritis with Lumbar / thoracic myelitis

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SCHILDER'S DISEASE, DIFFUSE SCLEROSIS

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

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Chronic Progressive Ophthalmoplegia

? friedreich's disease [hereditary ataxia]

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Intracranial lesions

? CONCUSSION INJURY TO

BRAIN

HEAD INJURY

? CEREBRAL CONTUSION

? FRACTURE BASE OF

SKULL

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Intracranial lesions

? PRIMARY OPTIC TUMOURS
? SECONDARY TUMOURS

ICSOLS

? HAMETOGENOUS LESION
? GRANULOMATOUS LESION
? PARASITIC CYST



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most common types in adults ?

? pituitary adenoma

? meningioma

? craniopharyngioma

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DIFFERENTIAL DIAGNOSIS OF ICSOL OCULAR FEATURES

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

2 Olfactory groove tumours (meningiomas)

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

3 Sphenoidal ridge tumours (meningiomas)

Proptosis

4 Pituitary tumours (adenomas)

Optic nerve ischemia then atrophy, Bitemporal heminopia, Colour

field defective

5 Suprasellar (Rathke's pouch) tumours

Papilloedema, diplopia(VI nerve involvement

(craniopharyngioma)

6 Median area tumours (Meningiomas)

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

7 Temporal lobe tumours (Gliomas,

Contralateral homonymous hemianopia(Incongruous)

meningiomas)

8 Occipital tumours

Congruous field defects

9 Cerebellar tumours (medulloblastoma)

Coarse horizontal nystagmus,Bilateral papilledema,diplopia(VI nerve

palsy)

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

neurofibromas, or gliomas in connection

24 wi

-03-2th a

022 coustic and vestibular nerves)
? Extraocular disturbances.

(a) Sensory.

(b) Motor.

(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

? Past

? Family

? Personal habits

? OPHTHALMOLOGICAL:

? Vision (BCVA)

? Visual fields and colour perception

? Pupil ary reflexes

? Displacement of the eyebal .

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CLINICAL APPROACH

? Extraocular movements(gaze

palsy, paralytic squint or

nystagmus)

? Dilated fundus examination with IO

( papilloedema, papillitis, optic

nerve atrophy, retinal

haemorrages, arteritis,

atherosclerotic changes ,etc..)

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HOW TO

INVESTIGATE...???

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investigations
? CBC with ESR

BASELINE

? URINE ROUTINE AND MICROSCOPY

Special Investigations-

? MRI brain with orbit

? CT scan

? Fundus flurorescein angiography

? B- scan

? VER

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investigations
And other special investigations(if needed):

? Viral markers

? Mantoux test for Tuberculosis

? CSF analysis

? VDRL for syphilis

? Orbital biopsy

? FNAC of lesion

? X-Rays if needed

? Angiography

? Doppler ultrasonography

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Summary

Detailed

Judicious

Careful

neuro-

use of

CORRECT

history

ophthalmic

neuroimag

Investigations

DIAGNOSIS and

evaluation

ing

TREATMENT

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