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Neuro-Ophthalmological Emergencies.

João Lemos1, Eric Eggenberger1

  • 1Michigan State University, East Lansing, MI, USA.

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|October 2, 2015
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Summary

Neuro-ophthalmological emergencies are critical conditions requiring immediate attention to prevent severe vision loss or life-threatening outcomes. Prompt diagnosis and treatment are essential for managing conditions like arteritic anterior ischemic optic neuropathy and pituitary apoplexy.

Keywords:
carotid artery dissectioncavernous sinus thrombosisemergency treatmentmucormycosispituitary apoplexytemporal arteritisthird nerve palsy

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Emergency Medicine

Background:

  • Neuro-ophthalmological emergencies present with vision or life-threatening symptoms like diplopia, visual loss, and anisocoria.
  • Delayed diagnosis and treatment lead to high morbidity and permanent sequelae.
  • Conditions such as arteritic anterior ischemic optic neuropathy, pituitary apoplexy, and cavernous sinus diseases pose significant risks.

Purpose of the Study:

  • To highlight the critical nature of neuro-ophthalmological emergencies.
  • To emphasize the importance of prompt diagnosis and management.
  • To inform neurohospitalists about critical conditions and their potential consequences.

Main Methods:

  • Review of clinical presentations and potential outcomes of various neuro-ophthalmological emergencies.
  • Discussion of specific conditions including arteritic anterior ischemic optic neuropathy, pituitary apoplexy, cavernous sinus thrombosis, mucormycosis, third nerve palsy, and Horner syndrome.
  • Emphasis on the diagnostic and therapeutic urgency.

Main Results:

  • Arteritic anterior ischemic optic neuropathy can lead to severe vision loss, stroke, or aortic dissection, necessitating immediate steroid therapy.
  • Pituitary apoplexy may be missed with standard computed axial tomography alone.
  • Cavernous sinus and orbital apex pathologies can cause simultaneous vision loss and diplopia, with potential for brain extension.
  • Isolated third nerve palsy may indicate a cerebral aneurysm, and Horner syndrome can signal carotid dissection.

Conclusions:

  • Neuro-ophthalmological emergencies demand rapid recognition and intervention to mitigate severe morbidity and mortality.
  • Familiarity with the workup and management of these emergencies is crucial for neurohospitalists.
  • Timely treatment can prevent permanent neurological deficits and life-threatening complications.