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Library of Congress Cataloging-in-Publication Data

Emergencies in neuro-ophthalmology : a case based approach / Andrew G. Lee . [et al.]. p. ; cm.

Includes bibliographical references and index. ISBN-13: 978-981-4295-01-7 (hardcover : alk. paper) ISBN-10: 981-4295-01-9 (hardcover : alk. paper)

1. Neuroophthalmology--Case studies. 2. Ophthalmologic emergencies--Case studies.

I.Lee, Andrew G.

[DNLM: 1. Optic Nerve Diseases--diagnosis--Case Reports. 2. Emergencies--Case Reports.

3. Optic Nerve Diseases--therapy--Case Reports. WW 280 E53 2010] RE725.E44 2010

617.7'32--dc22

2010011911

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library.

Copyright © 2010 by World Scientific Publishing Co. Pte. Ltd.

All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher.

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About the Authors

Andrew G. Lee MD is currently the Chairman of The Methodist Hospital (TMH) Department of Ophthalmology, and a Professor of Ophthalmology, Neurology and Neurosurgery, Weill Cornell Medical College. He is an Adjunct Professor of Ophthalmology at the University of Iowa Hospitals and Clinics, and a Clinical Professor of Ophthalmology, UTMB Galveston.

Paul W. Brazis MD is Professor of Ophthalmology and Neurology at the Mayo Clinic, Jacksonville, Florida.

At the time of this publication, Mansoor Moghul MD and Fabiana Policeni MD were fellows in Neuro-ophthalmology at the University of Iowa Hospitals and Clinics.

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Preface

The management of emergent neuro-ophthalmic conditions can be a life saving encounter for the general ophthalmologist. This book is designed to help the comprehensive ophthalmologist to make emergency triage decisions for initial evaluation and treatment of potentially visionor life-threatening conditions. This text is case-based and is intended to provide the reader with the opinion and expertise of two neuro-ophthalmologists. One, Dr. Lee is an ophthalmology-based neuro-ophthalmologist and the other, Dr. Brazis is a neurology-based neuro-ophthalmologist. Dr. Moghul and Dr. Policeni collected and collated the case vignettes during their fellowship with Dr. Lee at the University of Iowa Hospitals and Clinics.

It is the goal of this text to provide a concise, easy to read, and practical guide to the emergent evaluation of these neuro-ophthalmic conditions. This book is designed to be a quick read and not to be all inclusive or comprehensive. The reader is directed to longer and more comprehensive neuro-ophthalmic texts for this information. It is also not our intention to provide anatomy, pharmacology, physiology, or other basic mechanisms of disease. Instead, this text is meant to be a quick reference and resource for the clinician in the emergency room or in the clinic facing a potentially visionor lifethreatening emergency and to provide immediate guidance for potentially “high stakes” decision making. We also wish to emphasize that the recommendations of this text represent the authors’ own opinions on management and are not intended to be, nor should they be, construed as a “standard of care.” The case vignettes are based upon real clinical cases but the clinical details of each case have

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Emergencies in Neuro-Ophthalmology: A Case Based Approach

been modified for teaching purposes and represent composite rather than individual histories.

Each case vignette is composed of the relevant and concise medical history; the neuro-ophthalmic exam findings; the clinical and exam findings with demonstrative figures; and finally the expert opinion for management provided by Dr. Lee and Dr. Brazis.

We hope that the reader will enjoy the format and content of this text and we invite comments and feedback on the utility of our work.

Andrew G. Lee MD

Paul W. Brazis MD

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Acknowledgments

Dr. Lee would like to recognize and to thank his patient and always loving wife, Hilary A. Beaver MD for putting up with the writing of textbook #5. As the saying goes, “No man succeeds without a good woman behind him” and in my case I have had the honor of having five supportive women in my life; one wife (Hilary), my mother (Rosalind Lee MD), two daughters (Rachael and Virginia) and a sister (Amy Lee Wirts MD), so I feel blessed times five. I also thank my father (Alberto C. Lee MD) for instilling in me a passion for medicine and my brother (Richard Lee) for being a source of real world wisdom and providing a reality check from the non-MD side of the family. Finally, Dr. Lee thanks Dr. Brazis his co-editor for being the best friend and neuro-ophthalmology buddy a guy could ask for.

Dr. Brazis would like to thank his family, especially his wife Elizabeth, for their support and love. He also thanks Dr. Andrew Lee, his friend and colleague, who has taught him much over the years in neuro-ophthalmology, but also concerning friendship and life in general.

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Contents

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Emergencies in Neuro-Ophthalmology: A Case Based Approach

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