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Common Neuro-Ophthalmic Pitfalls: Case-Based Teaching by Valerie A. Purvin

By Valerie A. Purvin

Utilizing real-life instances describing sufferers with neuro-ophthalmic issues, this publication is a case-based educating device that bridges the space among textbook details and daily medical perform. each one case illustrates a selected sector of common diagnostic confusion, and highlights the categorical scientific beneficial properties that are meant to aspect to the proper analysis. concentrating on blunders during this method serves as motivation to the clinician to grasp the cloth in order that 'pitfalls' may be refrained from. the extent of the case discussions assumes that the reader has a few familiarity with uncomplicated neuroanatomy, body structure and disorder strategy yet every one case dialogue furnishes a quick overview of such details, continuously with an emphasis on these positive aspects which are clinically proper. The case-histories are succinct and amply illustrated, together with motility and fundus pictures, visible fields and radiographic reviews. The narrative is moved in addition to inquiries to the reader, making it effortless to stick to the common sense of the instances.

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Sample text

The fact that only one eye muscle was involved in the above case was an additional helpful feature. If this patient’s ocular motor dysfunction were due to a third nerve palsy, it would be a partial one. While partial third nerve palsies are common, isolated weakness of just one extraocular muscle is an extremely unusual presentation. Thus, it is important to consider other diagnostic possibilities when only one eye muscle is paretic, including myasthenia, internuclear ophthalmoplegia, myopathy and orbital restrictive disease.

Piette, R. C. Sergott, Pathological optic-disc cupping. Curr Opin Ophthalmol, 17 (2006), 1–6. J. D. Trobe, J. S. Glaser, J. Cassady, J. Herschler, D. R. Anderson, Nonglaucomatous excavation of the optic disc. Arch Ophthalmol, 98 (1980), 1046–50. 25 2 When orbital disease is mistaken for neurologic disease In most patients with orbital disease, the clinical presentation includes signs and symptoms that help localize the disease process to the orbit. Typical features include eye pain or pressure, proptosis, periorbital swelling, eyelid abnormalities, conjunctival injection and chemosis.

Based on the above findings, this patient’s motility disturbance was diagnosed as a long-standing muscle entrapment. As she was essentially asymptomatic, no specific treatment was indicated. Her headache pattern was consistent with migraine and was managed accordingly. Discussion: The limited elevation of the right eye in this patient, particularly in gaze up and to the right, suggested weakness of the right superior rectus muscle, and extensive investigation was therefore undertaken for a presumed partial third nerve palsy.

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