Alzheimer's disease is a progressive neurologic disorder which may present with visual disturbance before the diagnosis is clearly established. Central acuity and visual field are initially normal. Alzheimer patients may show anomalies of color vision, spatial contrast sensitivity, susceptibility to visual masks, fundus examination, ocular motility, higher cortical visual function, visual evoked potential, and pattern electroretinogram. Pathologic analysis has shown abnormalities at all levels of the visual axis from retinal ganglion cell to associative visual cortex. Correlations between the visual abnormalities of Alzheimer's disease and corresponding neuroanatomic substrates are discussed.

Adult↗

PubMedDate not supplied

Disc swelling in an adult diabetic patient.

A patient with insulin dependent adult onset diabetes presented with bilateral disc edema and minimal visual dysfunction. Initial work-up excluded an intracranial lesion, and a lumbar puncture revealed a normal opening pressure. The patient developed proliferative retinopathy, for which she received photocoagulation therapy. She subsequently developed an exacerbation and change of her disc swelling, associated with raised intracranial pressure. The differential diagnosis of diabetic papillopathy and papilledema is discussed.

Diabetes Mellitus, Type 1↗

PubMedDate not supplied

Disc edema, transient obscurations of vision, and a temporal fossa mass.

A 56-year-old woman presented with a four-month history of transient obscurations of vision that progressed to constant visual loss. She had a nodular, lumpy-bumpy, cauliflower-like asymmetric edema of the nerve head, which suggested direct optic nerve head invasion with foreign tissue. Imaging of her intracranial contents revealed a well circumscribed gadolinium enhancing mass in the middle fossa. Histopathology of material obtained at craniotomy revealed noncaseating granulomata consistent with sarcoidosis. Central nervous system sarcoid may present either as an infiltrative granulomatous process, or one of discrete tumor mass, masquerading as a neoplasm. Neurologic symptoms and signs often herald the presence of systemic disease. Our illustrates that isolated sarcoid optic neuropathy may occur and be associated with neither intraocular inflammatory signs nor extensive disease elsewhere; indeed, it may be the first declaration of neurosarcoidosis.

Brain Diseases↗

PubMedDate not supplied

Sudden visual loss with slow recovery.

A 58-year-old healthy man presented with a history of monocular visual loss with incomplete recovery. The differential diagnosis, evaluation, and possible therapeutic interventions are discussed. The presenter controversially felt that although the source of embolic material was likely ipsilateral carotid artery and no evaluation was necessary.

Blindness↗

PubMedDate not supplied

Symptomatic retrochiasmal lesions in multiple sclerosis: clinical features, visual evoked potentials, and magnetic resonance imaging.

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Hemianopsia↗

PubMedDate not supplied

Central American mesencephalopathy.

A 31-year-old Hispanic laborer sought medical attention for a four-day history of posterior headaches and double vision. The headache spontaneously resolved, but the patient continued to experience vertical diplopia. The neuro-ophthalmic exam revealed minimal anisocoria and subtle deficits of vertical motion of the left eye. MRI scanning demonstrated a lesion within the midbrain on the left side. Lumbar puncture revealed cells consisting primarily of lymphocytes and eosinophils. Both serum and cerebrospinal fluid revealed glycoproteins indicative of a cysticercosis infection. The patient was treated with Praziquantel and steroids with improvement of his oculomotor function.

Adult↗

PubMedDate not supplied

The Tübingen Study on Optic Neuritis Treatment--a prospective, randomized and controlled trial.

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Acute Disease↗

PubMedDate not supplied

Disk edema subsequent to renal transplantation.

A 12-year-old child was discovered (following successful renal transplantation) to have asymptomatic bilateral disk edema with preservation of optic nerve function. He had been maintained on cyclosporine, imuran and prednisone. Evaluation revealed normal intracranial imaging and normal CSF though under elevated intracranial pressure. The contributing possibilities to this papilledema are considered, and include a secondary pseudotumor cerebri syndrome of childhood and toxic effects of cyclosporine. The indications for treatment for pseudotumor cerebri are discussed, and clinicians are reminded to separate what we think about a case from how we behave in taking care of the patient.

Child↗

PubMedDate not supplied

She could not look to either side.

A young woman presented with the recent onset of an inability to move the eyes on a horizontal plane. Examination revealed limited horizontal gaze to the right and a complete left ophthalmoplegia. The limitation of eye movement could not be overcome by the doll's head maneuver. Other signs included bilateral orbicularis oculi weakness and brisk deep tendon reflexes. Her condition gradually improved and two months following the onset of the illness she was symptom free.

Acute Disease↗