Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Ophthalmology PPT 13 Ocular Present Cns Diseases Lecture Notes
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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
24-03-2022
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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This post was last modified on 07 April 2022