Neuro-ophthalmology

Abstract

SummaryThe field of neuro-ophthalmology is broad and interacts with other disciplines in neurology and ophthalmology along with neurosurgery, neuroradiology, rheumatology, and infectious disease. A number of interesting advances in diagnostic criteria, monitoring ability, and disease etiology have occurred in the last year that will improve our ability to take care of patients.A s a field, neuro-ophthalmology interacts with a large number of other specialties and as a result advances in any number of different fields apply to neuro-ophthalmology. The last year has produced a number of interesting advances in diagnosis, management, etiology, and treatment of a variety of different conditions seen by neuro-ophthalmologists.Idiopathic intracranial hypertension (IIH) is a relatively commonly seen neuro-ophthalmic disorder that if left untreated can produce severe visual loss. The diagnostic criteria for adults include a CSF pressure greater than 25 cm of water along with normal CSF constituents, normal neuroimaging, and a normal examination (abducens palsy allowed). IIH in the pediatric population is also well recognized but the criteria for what constitutes elevated pressure in this population have not been well established until now. In 2 articles from Children's Hospital of Philadelphia (CHOP), standard pressures for the pediatric population and the effect of position, legs flexed or extended, on pressure were established.1,2 A prospective study measured CSF pressure in 197 patients age 1-18, none of whom were on medications that would influence intracranial pressure or had a medical condition that would influence intracranial pressure. A normal range of 11.5-28 cm of water was established. Moderate to deep sedation produced a slightly higher opening pressure than no sedation and a small but statistically significant effect of body mass index (BMI) on CSF pressure was noted. A post hoc analysis of 52 patients with normal BMI and no sedation showed an upper limit of 25 cm of water for opening pressure. These findings were replicated in a smaller study of 44 patients from the University of Mississippi.3 Using the same 10%-90% range of values the CHOP group used, these authors found a range of 11-32 cm of water for CSF pressure in normal controls. In a second study, the CHOP group measured opening pressure with the legs flexed and again with the legs extended.