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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24-03-2022INTRODUCTION
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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24-03-2022INTRODUCTION
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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24-03-2022HOW DO THE PATIENT PRESENT ?
24-03-2022
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CLINICAL PRESENTATIONSYMPTOMS:
? 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
24-03-2022
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CLINICAL PRESENTATIONSIGNS:
? Nystagmus
? Gaze palsy
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? Paralytic squint [Cranial Nerve palsies-VI, VI , IV]24-03-2022
Intracranial lesions
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? MENINGITIS? ENCEPHALITIS
INFECTIONS
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? BRAIN ABSCESS
? NEUROSYPHILIS
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24-03-2022Intracranial 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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? HYDROCEPHALOUS24-03-2022
INTRACRANIAL ANEURYSMS- 2 to 3 %
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? in the region of circle of willis1. Congenital weakness in the wall
2. Post traumatic
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3. Post infection? Carotico-cavernous fistula
24-03-2022
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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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24-03-2022
HYDROCEPHALOUS
? Congenital
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? acquired24-03-2022
Intracranial lesions
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? MULTIPLE SCLEROSIS
DEMYLENATING
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? NEUROMYELITIS OPTICALESIONS
? SCHILDER'S DISEASE
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24-03-2022
MULTIPLE SCLEROSIS
? Loss of sensory or motor function of different parts of body
? Optic neuritis
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? Sudden DV24-03-2022
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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24-03-2022
Chronic Progressive Ophthalmoplegia
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? friedreich's disease [hereditary ataxia]24-03-2022
Intracranial lesions
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? CONCUSSION INJURY TOBRAIN
HEAD INJURY
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? CEREBRAL CONTUSION
? FRACTURE BASE OF
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SKULL24-03-2022
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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24-03-2022
most common types in adults ?
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? pituitary adenoma? meningioma
? craniopharyngioma
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24-03-2022
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 -fosterkennedy 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) tumoursPapilloedema, 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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24-03-2022HOW DO WE CLINICALLY APPROACH........
24-03-2022
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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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24-03-2022
CLINICAL APPROACH
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? Extraocular movements(gazepalsy, paralytic squint or
nystagmus)
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? Dilated fundus examination with IO
( papilloedema, papillitis, optic
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nerve atrophy, retinalhaemorrages, arteritis,
atherosclerotic changes ,etc..)
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24-03-2022
HOW TO
INVESTIGATE...?
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24-03-2022
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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? VER24-03-2022
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
24-03-2022
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Summary
Detailed
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JudiciousCareful
neuro-
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use of
CORRECT
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historyophthalmic
neuroimag
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Investigations
DIAGNOSIS and
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evaluationing
TREATMENT
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24-03-2022