Role of imaging in the management of neuro-ophthalmic disorders

Abstract

Advancements in physics, computers, and imaging science in the last century have seen neuro-imaging evolving from a plain X-ray to computed tomography, magnetic resonance imaging scans, noninvasive angiography, and special sequences such as fat suppression, fluid attenuation recovery and diffusion-weighted imaging. A prompt prescription of an appropriate imaging modality and the most suitable sequence can increase the diagnostic yield, and in many instances, it can be a sight-saving and even a life-saving decision. This article discusses basic principles of neuro-imaging, its common indications, and the appropriate application in an ophthalmology practice.

Permanent Unilateral Vision Loss From Allergic Fungal Sinusitis

“…5 These neuro-ophthalmic manifestations found on examination pointed to the patient's likely pathology being an injury to the optic nerve by an extrinsic lesion, which then prompted MRI imaging of the brain and orbits. 6 In emergent situations such as acute visual loss, understanding the appropriate imaging and the additional benefits of contrast agents has significant value from a diagnostic standpoint and timeliness to treatment. In our patient with acute unilateral visual loss, MRI is the optimal imaging for evaluating the optic nerve and optic chiasm, as it provides superior soft tissue discrimination of intracranial anatomy.…”

“…In our patient with acute unilateral visual loss, MRI is the optimal imaging for evaluating the optic nerve and optic chiasm, as it provides superior soft tissue discrimination of intracranial anatomy. [5][6][7] In cases with a high clinical suspicion for optic neuropathy, neuroimaging is mandatory to assess for the possibility of compression as a cause. Magnetic resonance imaging in this case confirmed the presence of a heterogeneous mass abutting the left optic nerve at the level of the orbital apex and led to the decision for surgical decompression.…”

“…These neuro-ophthalmic manifestations found on examination pointed to the patient’s likely pathology being an injury to the optic nerve by an extrinsic lesion, which then prompted MRI imaging of the brain and orbits 6 . In emergent situations such as acute visual loss, understanding the appropriate imaging and the additional benefits of contrast agents has significant value from a diagnostic standpoint and timeliness to treatment.…”

Overview and Imaging of Orbital Tumors

“…Whereas many pathologic processes intrinsic to the globe may be easily evaluated under direct visualization, radiological imaging is of greater value in the evaluation of orbital and intracranial processes. In current practice, imaging including CT and MRI is the gold standard for diagnosis and management [28][29][30][31] (Tables 10.2 Complete blood count (CBC) and clotting studies including prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT), to assess blood clotting function of the patient Tests to diagnose cancer at the time of biopsy Frozen-section, histopathology, immunohistochemistry, Immunophenotyping Flow-cytometry, DNA sequencing and antibody/gene microarray, PCR, quantitative PCR Tests to make a management plan Confirmation of tumor type and staging for chemo and radiation treatments Tests to determine the dissemination of cancer; sentinel node biopsy; LP cytology; BM biopsy Tumor marker tests to measure the presence, levels, or activity of specific proteins or genes in tissue and blood that may indicate the presence of cancer. A tumor that shows greater than normal level of a certain tumor marker may respond to treatment with a drug targeting that specific marker Tests to monitor the patient during treatment and look for adverse effects of the treatment Urinalysis; CBC; blood chemistry; tests detect metabolites, electrolytes, fats, and proteins, and enzymes including blood urea nitrogen (BUN) and creatinine and many others Tests to determine whether the tumor is responding to treatment and tests to monitor recurrence Clinical Laboratory tests can be useful for orbital tumor patient for numerous purposes.…”

Minimally invasive surgery for thyroid eye disease

“…This is crucial in surgical planning in terms of surgical steps as well as prognostication in terms of final proptosis reduction. [ 12 ] Additional information obtained from CT scan includes the level of cribriform plate, the thickness of orbital floor, and also the presence of infraorbital canal, all having a bearing on the complexity of the surgical technique.…”