Visual evoked responses and ophthalmological examination in optic neuritis
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Optic neuritis
Neuritis
Neurological examination
The neurological examination is an important tool in the evaluation of a newborn, helping to establish a diagnosis, and providing prognostic information. Neurological disorders may be apparent before birth or appear during the course of the neonatal period. The neonatal neurological examination varies by gestational age and state, which makes the examination a changing and dynamic process. This article reviews the essentials of the neonatal neurological examination, the presence of examination findings based on gestational age, normal and abnormal physical examination findings, and how the examination helps to identify various disorders.
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A 57-year-old woman developed bilateral optic neuritis after being treated for 6 months with tamoxifen in the dosage of 30 to 40 mg orally a day. As the neuritis progressed during continued treatment and no other causal explanation could be found, tamoxifen was stopped and the optic neuritis regressed. Since tamoxifen might cause optic neuritis the authors recommend the monitoring of ocular symptoms in treated patients.
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Herein, we report a case with neuromyelitis optica (NMO) who presented with optic neuritis and visual field examination revealed superior altitudinal visual field defect. Via the presentation of this patient, we point out NMO as an alternative differential diagnosis in patients with altitudinal visual defect clinics. Based on this presentation and literature data, we discuss some hypotheses about pathogenesis of optic neuritis in NMO and underlying mechanisms of optic neuritis development presenting with altitudinal visual defect as well. J Neurol Res. 2017;7(6):112-114 doi: https://doi.org/10.14740/jnr463w
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Neuromyelitis Optica
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Examination of 166 patients with optic neuritis revealed that 65 of them developed multiple sclerosis (MS) at different times after optic neuritis. The observation period was 9.4 years on the average. Using the clinical, laboratory, immunogenetic methods the clinico-immunogenetic heterogeneity of optic neuritis was discovered, the highly informative specific clinical signs and immunogenetic markers suitable as criteria for predicting different variants of optic neuritis outcomes were defined. Using a heterogeneous successive procedure a method of individual ++pre-nosological prediction of MS in persons with a history of optic neuritis was devised.
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Herein, we report a case with neuromyelitis optica (NMO) who presented with optic neuritis and visual field examination revealed superior altitudinal visual field defect. Via the presentation of this patient, we point out NMO as an alternative differential diagnosis in patients with altitudinal visual defect clinics. Based on this presentation and literature data, we discuss some hypotheses about pathogenesis of optic neuritis in NMO and underlying mechanisms of optic neuritis development presenting with altitudinal visual defect as well. J Neurol Res. 2017;7(6):112-114 doi: https://doi.org/10.14740/jnr463w
Optic neuritis
Neuromyelitis Optica
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Patients with acute optic neuritis typically present with acute loss of vision. We describe a case of a young lady of 25 years of age with blurring of vision in the upper visual field of the right eye with otherwise intact visual acuity as the only presenting symptom. Although altitudinal visual field defect is not unknown to be associated with acute optic neuritis, it is generally considered a relatively uncommon occurrence. Our case illustrates an unusually unique occurrence of upper altitudinal visual field defect in association with unaffected visual acuity as the sole presenting symptom of acute idiopathic unilateral optic neuritis. When an altitudinal visual field defect is a presenting feature, besides the usual vascular and compressive causes, optic neuritis should be remembered in the list of differential diagnoses.
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The aim of our study was to evaluate visual field in patients with multiple sclerosis without a history of optic neuritis. We assessed presence and localisation of visual field defects and evaluated correlation between visual field disturbances and patient's neurological status.A group of 52 patients with multiple sclerosis and 17 healthy persons who served as the control group were enrolled into the study. The patients went through a routine neurological examination, ophthalmologic check-up and perimetric visual field assessment. Visual fields were examined with static perimetry Medmont M700. In all of the patients, results of perimetry were evaluated according to localisation of lesions. A decibel scale was used to quantitatively assess disturbances in patient's visual field.We found that "asymptomatic" visual field disturbances were present in a large number (38, 73.1%) of multiple sclerosis patients. Among these patients, we diagnosed concentric visual field lesions in 46.2%, and we recognized disturbances in the upper part of the visual field in 26.9%. There was a correlation between the presence of those visual field lesions, duration of multiple sclerosis, and the degree of patients' disability.Asymptomatic visual field disturbances occur frequently in MS patients (despite no history of retrobulbar optic neuritis). Static perimetry may be a valuable, complementary method in addition to examinations used so far in the diagnosis of multiple sclerosis.
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We compared the visual field in 46 eyes of 34 cases with optic neuritis, which included 17 cases with multiple sclerosis (MS) and 17 cases with unknown causes. The visual field examination was measured by program 31 of the Octopus automated perimeter, which tests the central 30 degree field in a 6-degree grid. All eyes had visual acuity of 0.2 or better. The mean visual acuity was 0.97 in MS and 0.83 in the unknown etiology cases. There were no differences in the rate of abnormalities in the 30 degree-field between MS and unknown cases. The mean sensitivity loss of the abnormal visual field with MS was significantly greater than that of the unknown cases. The 30 degree field was divided into 3 sections. MS had almost the same mean sensitivity loss in each section. The cases of unknown etiology had a greater mean loss in 0-10 degrees than that in the other sections. We could conclude therefore that diffuse visual field loss was caused by MS and central depression of 0-10 degrees in the 30 degree field was secondary to an unknown cause. In comparison to the affected eyes seventeen eyes with normal visual acuity and no history of optic neuritis were tested by program 31. Results showed that 3 eyes had abnormal points in 10-30 degree sections.
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The purpose of the present study was to determine the baseline visual field characteristics in 448 patients with acute optic neuritis who were entered into the Optic Neuritis Treatment Trial. The severity and pattern of visual field loss in both the affected and fellow eyes were classified. For affected eyes, diffuse visual field loss was present in 48.2% of eyes, central or centrocecal scotoma was present in 8.3% of eyes, altitudinal or other nerve-fiber bundle-type defects were present in 20.1% of eyes, and a variety of other defects were present in 23.4% of eyes. Visual field involvement was present in the fellow eye at baseline in 308 (68.8%) of the 448 patients. Evidence of a chiasmal or retrochiasmal visual field defect was present in 2.9% of the patients. Since a wide variety of visual field defects can occur with an acute attack of optic neuritis, the pattern of visual field loss is of limited utility in distinguishing optic neuritis from ischemic optic neuropathy and other optic nerve disorders. Asymptomatic visual field defects in the fellow eye are common.
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SECTION I. NEUROLOGIC DIAGNOSIS: GENERAL CONSIDERATIONS * The Role of the Neurologic Examination in Neurologic Diagnosis * Localization of Neurologic Disease (Or What ...opathy does the Patient Have?) * Mechanisms of Neurologic Disease SECTION II. THE NEUROLOGIC EXAMINATION THE NEUROLOGIC HISTORY * Taking a Neurologic History THE MENTAL STATUS EXAMINATION * The Approach to the Mental Status Examination * Language Testing * Memory Testing * The Mini-Mental-Status Examination THE CRANIAL NERVE EXAMINATION * The Approach to the Examination of the Cranial Nerves * Examination of the Pupils * The Fundoscopic Examination * Examination of Visual Acuity * The Visual Field Examination * Examination of Eye Movements * Examination of Facial Sensation * Examination of Facial Strength * Examination of Jaw Strength * Examination of Hearing * Examination of Palatal Function * Examination of Tongue Movement * Examination of the Sternocleidomastoid and Trapezius Muscles * Examination of Taste * Examination of Smell THE MOTOR EXAMINATION * The Approach to the Motor Examination * Examination of Upper Extremity Strength * Examination of Lower Extremity Strength * Examination of Tone THE SENSORY EXAMINATION * The Approach to the Sensory Examination * Examination of Pin and Temperature Sensation * Examination of Vibration and Position Sensation * Examination of Cortical Sensation * Romberg Testing THE CEREBELLAR EXAMINATION * The Approach to the Cerebellar Examination * Testing of Upper Extremity Cerebellar Function * Testing of Lower Extremity Cerebellar Function THE REFLEX EXAMINATION * The Approach to Reflex Testing * Examination of Deep Tendon Reflexes * Testing for Babinski Response THE GAIT EXAMINATION * The Approach to the Gait Examination * Examining Gait PUTTING IT ALL TOGETHER * Performing a Complete Neurologic Examination SECTION III. THE NEUROLOGIC EXAMIINATION IN COMMON CLINICAL SITUATIONS * Tailoring the Neurologic History and Examination to the Clinical Scenario * Examination of the Comatose Patient * Examination of the Confused Patient * Examination of the Patient with Dementia * Examination of the Dizzy Patient * Examination of the Patient with Falls * Examination of the Patient with Headache * Examination of the Patient with Tremor and Other Abnormal Movements * Examination of the Patient with Numbness * Examination of the Patient with Back Pain * Examination of the Patient with Neck Pain * Examination of the Patient with a Speech Problem * Examination of the Patient with Syncope * Examination of the Patient with Transient Focal Neurologic Symptoms * Examination of the Patient with Visual Problems * Examination of the Patient with Weakness * Examination of the Patient with a Suspected Spinal Cord Problem * Examination of the Patient with a Suspected Stroke * Examination of the Patient without Neurologic Symptoms: The Screening Neurologic Examination
Neurological examination
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