Controversies in Neuro-Ophthalmology: 1st Edition (Hardback) book cover

Controversies in Neuro-Ophthalmology

1st Edition

Edited by Andrew G. Lee, Jacinthe Rouleau, Reid Longmuir

CRC Press

108 pages | 175 B/W Illus.

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pub: 2009-12-18
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Description

Neuro-ophthalmology, like in any field of medicine, has many areas where controversy exists in diagnosis and treatment. Controversies in Neuro-Ophthalmology provides a comprehensive overview on the clinical presentation, diagnosis, and management of neuro-ophthalmic disorders and specifically addresses areas where there is a general lack of consensus amongst practitioners.

Each chapter opens with a case to illustrate a pertinent controversy and then poses a clinical question. The issue is then discussed by world leading experts to provide a balanced viewpoint. Designed to foster vigorous debate among colleagues, this book is essential reading for neuro-ophthalmologists, ophthalmologists, and neurologists.

 

Table of Contents

Should a patient with unexplained isolated optic atrophy have neuroimagingand further laboratory evaluation?

Pro: A patient with unexplained isolated optic atrophy should have neuroimagingand further laboratory evaluation 1

Nicholas Volpe

Con: A patient with unexplained isolated optic atrophy does not always need neuroimagingand further laboratory evaluation

Karl Golnik

Should a young patient with a new diagnosis of optic neuritis have testing andtreatment for multiple sclerosis (MS)?

Pro: A young patient with a new diagnosis of optic neuritis should have testing andtreatment for multiple sclerosis if identified

Fiona Costello

Con: A young patient with a new diagnosis of optic neuritis does not alwaysrequire testing and treatment for MS

Michael S Lee

Should a patient with optic disc edema with a macular star figure (neuroretinitis)have lab testing and treatment?

Pro: Test for cat scratch, Lyme, syphillis, tuberculosis (Tb) and treat empiricallyfor cat scratch fever

Karl Golnik

Con: Do not test for cat scratch, Lyme, syphillis, tuberculosis (Tb) and do not treat for cat scratch fever

Eric Eggenberger

Should a vasculopathic patient with nonarteritic anterior ischemic optic neuropathyhave any testing?

Pro: Test for blood pressure (nocturnal hypotension, 24 hour blood pressuremeasurements), sleep apnea, blood sugar, cholesterol, no smoking, aspirin per day

Karl Golnik

Con: Do not test for blood pressure (nocturnal hypotension, 2hour blood pressuremeasurements), sleep apnea, blood sugar, cholesterol, no smoking, aspirin per day

Michael S Lee

What is the treatment for giant cell arteritis?

Pro: Patients with suspected gcaand vision loss should receive ivsteroids followed byoral prednisone and antiplatelet therapy while awaiting temporal artery biopsy

Timothy J McCulley and Thomas Hwang

Con: Oral steroids are adequate treatment for gca

Eric Eggenberger

Should I do a bilateral or unilateral temporal artery biopsy in suspectedgiant cell arteritis?

Pro: A bilateral temporal artery biopsy should be strongly considered in casesof suspected GCA

Michael S Lee

Con: A unilateral temporal artery biopsy is usually adequate

Wayne T Cornblath

Should I treat traumatic optic neuropathy?

Pro: Treat traumatic optic neuropathy with high-dose steroid or possibly surgery

Nicholas Volpe

Con: There is no proven treatment for traumatic optic neuropathy

Eric Eggenberger

Should I do a MRI and MR venogram in every patient with pseudotumor cerebri?

Pro: MRI and MRV are necessary in the workup of possible pseudotumor cerebri

Nicholas Volpe

Con: MRI scan with contrast is adequate in the evaluation of possible pseudotumor cerebri and avenogram is usually unnecessary

Fiona Costello

Should we perform carotid Doppler and cardiac echo on young patientswith transient visual loss?

Pro: Transient vision loss in young people can be thromboembolic so work upshould be performed

Nicholas Volpe

Con: Transient vision loss in young people does not routinely require a cardiovascularrisk factor assessment

Fiona Costello

What is the best visual field test for neuroophthalmology?

Pro: Goldmann (kinetic) is better

Fiona Costello

Con: Automated is better

Wayne T Cornblath

contents

Does visual rehabilitation therapy help patients with homonymous hemianopsia?

Pro: Vision rehabilitation therapy can be useful in cases of homonymousvisual field loss

Wayne T Cornblath

Con: Vision rehabilitation therapy is not helpful in cases of homonymousvisual field loss

Eric Eggenberger

Should a patient with a pupil involved third nerve palsy have a catheter angiogramif the MRA or CTA are negative?

Pro: A patient with a pupil-involved third nerve palsy should have an angiogramif the MRA or CTA are negative

Timothy J McCulley and Soraya Rofagha

Con: A negative mraor ctais adequate in the evaluation of a pupil-involved third nerve palsy

Michael S Lee

Do erectile dysfunction agents cause anterior ischemic optic neuropathy?

Pro: Erectile dysfunction agents do cause anterior ischemic optic neuropathy

Karl Golnik

Con: Erectile dysfunction agents have never been proven to cause ischemic optic neuropathy

Timothy J McCulley and Michael K Yoon

Does amiodarone produce an optic neuropathy?

Pro: Amiodarone does cause an optic neuropathy

Eric Eggenberger

Con: Amiodarone does not cause an optic neuropathy

Timothy J McCulley and Shelley Day

Should I start my patient with myasthenia gravis on steroids to reduce the chanceof generalized myasthenia gravis?

Pro: Steroids may prevent generalized myasthenia gravis in patients presenting with anisolated ocular form of the disease 79

Nicholas Volpe

Con: Steroid should not be given to prevent onset of generalized myasthenia gravis

Michael S Lee

Does radiation therapy work for thyroid ophthalmopathy?

Pro: Low dose orbital radiation therapy is a useful alternative in the treatment ofthyroid eye disease

Reid Longmuir

Con: Radiation therapy is not helpful in the treatment of thyroid eye disease

Karl Golnik

contents

Should I do topical pharmacologic testing in the Horner syndrome?

Pro: Pharmacologic testing is useful in the evaluation of possible Horner’s syndrome

Fiona Costello

Con: Pharmacologic testing is not necessary in the evaluation of possible Horner’ssyndrome and one should proceed directly to neuroimaging

Nicholas Volpe

Should a patient with giant cell arteritis have a fluorescein angiogram?

Pro: A fluorescein angiogram is useful in the evaluation of suspected giant cell arteritis

Fiona Costello

Con: Fluorescein angiography is usually not necessary in the evaluationof possible giant cell arteritis

Eric Eggenberger

Does pseudotumor cerebri without papilledema exist?

Pro: Idiopathic intracranial hypertension (IIH) without papilledema does exist

Timothy J McCulley and Thomas N Hwang

Con: Pseudotumor cerebri without papilledema does not exist

Michael Lee

Does a patient with an isolated vasculopathic ocular motor cranial nerve palsyneed a neuorimaging study?

Pro: Despite a clinical diagnosis of ischemic cranial nerve palsy, neuroimagingshould be strongly considered

Nicholas Volpe

Con: A clinical diagnosis of ischemic cranial nerve palsy excludes the needfor neuroimaging

Wayne T Cornblath

Subject Categories

BISAC Subject Codes/Headings:
MED056000
MEDICAL / Neurology
MED085000
MEDICAL / Surgery / General
SCI089000
SCIENCE / Life Sciences / Neuroscience