585

Index

Note: Page numbers followed by f and t indicate figures and tables, respectively.

AAbducens nerve. See Cranial nerve(s),

VI; Sixth nerve palsy(ies)Abduction deficit. See also Esotropia

isolated, pearls, 373Abnormal visual perception(s)

drug-induced, 268in neurologic disorders, 263–268in ophthalmic disorders, 261–262optical causes, 261in optic nerve disease, 262in psychiatric disorders, 261retinal disorders causing, 261–262,

262ftoxin-related, 268

Abscessoccipital, and binocular visual loss, 126orbital, 343, 344f

Acanthamoeba keratitis, 111fAccommodation, nonorganic weakness

or paralysis, 509Achromatopsia, 256

congenital, 303Acquired immunodeficiency

syndrome. See also Human immunodeficiency virus (HIV)

neurologic and ocular involvement in, 564f, 565, 565f, 566f

Acute disseminated encephalomyelitis, 180, 184, 188–189

Acute idiopathic blind spot enlargement syndrome, 121, 122, 122f

Acute zonal occult outer retinopathy, 121Adduction deficit. See ExotropiaADEM. See Acute disseminated

encephalomyelitisAdie pupil, 273, 296–298, 297f

causes, 298pharmacologic testing for, 298, 299fprognosis for, 298signs and symptoms, 296, 297f

Adie syndrome, 297fAge-related macular degeneration, 40f,

119, 119fdry, 119wet, 119

AIBSE. See Acute idiopathic blind spot enlargement syndrome

AIDS. See Acquired immunodeficiency syndrome

AION. See Anterior ischemic optic neuropathy

Akinetopsia, 256, 258tAlbinism, 472Alcohol

hallucinations/illusions caused by, 268maternal use of, and optic nerve

hypoplasia, 230withdrawal, hallucinations/illusions

caused by, 268Alexia, 256

without agraphia, 257tAlice in Wonderland syndrome, 264,

266Altitudinal defect(s), 56

with ischemic optic neuropathy, 194, 195f

Alzheimer diseaseand binocular visual loss, 126hallucinations/illusions in, 263neurologic and ocular involvement in,

256, 260Amaurosis fugax, 133Amblyopia, 124–125, 441

causes, 125Amiodarone, optic neuropathy caused

by, 221, 223Amniotic fluid embolism, and Purtscher

retinopathy, 169Amsler grid, 6, 6f, 26t

bedside testing with, 44, 45fAncillary testing, 76. See also Laboratory

testingAneurysm(s). See also Posterior

communicating artery, aneurysm

anterior inferior cerebellar artery, clinical manifestations, 544t

basilar artery, clinical manifestations, 544t

carotid cavernous, 437, 438f, 451, 451f, 452f

carotid-ophthalmic, clinical manifestations, 543t

cavernous sinus, 404, 404f, 452fclinical manifestations, 543t

586 Index

Aneurysm(s) (cont.)endovascular treatment, 105, 106finternal carotid artery, 540f

on catheter angiogram, 105fintracranial

clinical manifestations, 542, 542f, 543t–544t

common sites, 540frupture, and subarachnoid

hemorrhage, 541, 541f, 542, 542f, 543t–544t, 544t

and third nerve palsy, 300, 300f, 301, 389, 392–394, 392f, 393f, 394f, 438

middle cerebral artery, clinical manifestations, 543t

ophthalmic arteryclinical manifestations, 543tand compressive optic neuropathy,

207posterior cerebral artery, clinical

manifestations, 544tposterior inferior cerebellar artery,

clinical manifestations, 544tsuperior cerebellar artery, clinical

manifestations, 544tsuperior hypophyseal artery, clinical

manifestations, 543tvertebral artery, clinical

manifestations, 544tAngiitis. See also Vasculitis

central nervous system, 545–547, 546f

cerebral, 545–547mimickers of, 547

primary, 547Angiography. See Catheter angiography;

CT angiography; Fluorescein angiography; Magnetic resonance angiography (MRA)

Angiopathy(ies), of CNS, associated with ocular manifestations, 527, 528t–529t

Angle closure glaucoma, 282fanisocoria caused by, 283and transient monocular visual loss,

134, 134fAniridia, anisocoria caused by, 283Anisocoria, 14, 14f, 278–301

associated signs and symptoms, 280causes, 280–301

ocular, 281–283, 281f–283fdecision tree for, 302fdefinition, 11diagnosis, 279–280, 279f, 280flarge pupil abnormal, 280, 280f,

294–301causes, 294–301

physiologic, 269, 280–281, 281fsmall pupil abnormal, 279, 279f,

284–294with third nerve palsy, 388, 389, 438,

439fAnisometropia, uncorrected, 125Anterior cerebral artery

on catheter angiogram, 103f, 105fmagnetic resonance angiography of,

101fAnterior ciliary artery(ies), 136, 136f,

137fAnterior communicating artery,

aneurysm, 540fclinical manifestations, 543t

Anterior inferior cerebellar artery (AICA), aneurysm, clinical manifestations, 544t

Anterior ischemic optic neuropathy, 151, 151f, 180, 195, 237, 239, 548, 548f, 551

arteritic, 204–206, 205fcharacteristics, 197t

clinical characteristics, 181tdifferentiation from optic neuritis,

196, 197tand disk-at-risk, 196, 196f, 198f, 199and disk edema, 241fluxury perfusion in, 197, 199fnonarteritic. See also Diabetic

papillopathycauses, 199–200characteristics, 197–199, 197t, 198fnatural history, 202pearls, 200risk factors for, 200–202, 201f, 202ftreatment, 202

pearls, 196Anterior segment disorders

anisocoria caused by, 283postoperative, 571and visual loss, 110

Anterior uveitis, 16f, 281fanisocoria caused by, 283

Anticholinergic agents, hallucinations/illusions caused by, 268

Antidepressants, hallucinations/illusions caused by, 268

Antiparkinsonian agents, hallucinations/illusions caused by, 263, 268

Antipsychotics, hallucinations/illusions caused by, 268

Anton syndrome, 268Aortic arch atheroma, evaluation of

patients with, 152tAponeurotic defect, ptosis caused by,

488, 489, 489f

Index 587

Apraclonidinein diagnosis of Horner syndrome, 285,

286, 287fand ptosis, in Horner syndrome, 492,

492ffor treatment of Horner syndrome,

294Apraxia of eyelid opening, 488, 493Arcuate defect(s), 56, 58fArgyll Robertson pupils, 303Arteriovenous malformation

intracranial, 539foccipital, 539fretinal, 538f

Artery(ies), retinalattenuation, 37f

with branch retinal artery occlusion, 148

with central retinal artery occlusion, 146

in giant cell arteritis, 151f, 551focclusion, 145–153

types, 145–151sheathing, in retinal vasculitis, 165f,

166, 166fAspergillosis, optic neuritis associated

with, 184Astigmatism, uncorrected, 125Ataxia(s). See also Autosomal dominant

progressive optic atrophy with progressive hearing loss and ataxia; Optic ataxia; Sex-linked recessive optic atrophy, ataxia, deafness, tetraplegia, and areflexia

Friedreich, 217hereditary, associated with optic

neuropathy, 217spinocerebellar, 217

Ataxia-telangiectasia (AT), neurologic and ocular involvement in, 528t, 577, 577f

Aura, migrainous, 515–516visual, 128, 129f, 132t, 263–264, 263t,

264f, 516Automated static perimetry, 49–50,

50fin nonorganic visual field

constriction, 506, 506fAutosomal dominant optic atrophy. See

Dominant optic atrophyAutosomal dominant progressive optic

atrophy and deafness, 217Autosomal dominant progressive optic

atrophy with progressive hearing loss and ataxia, 217

AZOOR. See Acute zonal occult outer retinopathy

BBacterial infection

cerebral angiitis associated with, 546optic neuritis associated with, 184

Balint syndrome, 256, 260Band keratopathy, 498Bartonella henselae. See Cat scratch

diseaseBasal cell carcinoma, 406Basilar artery, 131, 131f

aneurysm, clinical manifestations, 544ton catheter angiogram, 104fmagnetic resonance angiography of,

101fstenosis/occlusion, 131

Behçet syndrome, retinal vasculitis in, 166, 167

Behr syndrome, 217Bell phenomenon, 318, 318f, 497, 497fBenedikt syndrome, lesion location in,

440tBenign episodic pupillary mydriasis, 304Benzodiazepines, withdrawal,

hallucinations/illusions caused by, 268

Bitemporal hemianopia, 60, 60fBlepharophimosis syndrome, 487Blepharospasm, 500, 500f

nonorganic, 510Blindness, cerebral, 131, 132, 268Blindsight, 267Blind spot, physiologic, 41

acquired enlargement of, 121–122, 122f

Blinkingabnormal, 500, 500f

definition, 482decreased, 500

Botulinum toxin injectionfor blepharospasm, 500for diplopia, 442for hemifacial spasm, 500

Botulism, 397, 410Bourneville disease. See Tuberous

sclerosisBowtie atrophy. See Optic tract.Brain

blood supply to, 129–131, 130f, 131fvenous system, 530f, 531f

Brain injury, traumatic, neurologic and ocular involvement in, 569–570

Brainstemlesion

and diplopia, 348and multiple cranial nerve

involvement, 397veins of, 532, 532f

588 Index

Brain tumor(s), 245, 245f. See also Tumor(s)

Branch retinal artery(ies), 137femboli in, 137f, 138occlusion, 145, 148–150, 149f

Branch retinal vein occlusion, 155–159acute, 156f, 157

Breast cancer, orbital metastases, 346, 347f, 447, 447f

Brown syndrome, 356–357acquired, 346, 356–357congenital, 356–357, 357f

Bull’s-eye maculopathy, 123, 123f

CCADASIL, 525, 529tCafé au lait spots, 572, 572fCalcium emboli, characteristics, 150tCaloric test, 336

in comatose patient, 25Cancer-associated retinopathy, 124, 262Cancer patient(s)

increased intracranial pressure in, 568–569

with neuro-ophthalmic symptoms, management, 568

CAR. See Cancer-associated retinopathyCarbon monoxide poisoning, palinopsia

caused by, 266Carcinomatous meningitis, 568–569Carotid artery(ies). See also External

carotid artery(ies) (ECA); Internal carotid artery(ies) (ICA)

on catheter angiogram, 103f, 105fdisease

differential diagnosis, 522evaluation of patients with, 152tocular manifestations, 522

dissection, 522, 523f, 524fintracavernous, lesion, 437, 438fmagnetic resonance angiography of,

101f, 102fstenosis, 140ultrasound of, 97–98, 97f, 98f

Carotid cavernous aneurysm, 437, 438f, 451, 451f, 452f

Carotid cavernous fistula, 239, 452–459, 453f

B-scan echography of, 86, 87fclassification, 454clinical features, 454–459, 454f, 455fdiagnosis, 457, 457f, 458f, 459and diplopia, 348direct, 454, 455f, 456ffundus findings with, 455, 456findirect, 454, 454f, 456fpearls, 456

prognosis for, 459traumatic, 17ftreatment, 459

Carotid cavernous thrombosiscauses, 459clinical features, 459, 460fprognosis for, 460treatment, 460

Cataracts, 112fChristmas tree, 355, 356fin ocular ischemic syndrome, 154,

154fand red reflex, 33, 34f

Catheter angiography, 103–105, 103f–106f, 149f

of carotid cavernous fistula, 457, 458f, 459

cerebral, in headache/facial pain, 518complications, 103indications for, 103

Cat scratch diseaseneurologic and ocular involvement in,

563, 566, 566foptic neuritis associated with, 184,

192, 193fand retinal vasculitis, 167

Cavernous hemangioma(s)intracranial, 538fretinal, 171f, 538f

Cavernous sinusanatomy, 292f, 400–401, 400f, 401faneurysm, 404, 404f, 452f

clinical manifestations, 543tdisorders, 449–462lesion, 437

and Horner syndrome, 291, 291f, 397, 437

and multiple cranial nerve involvement, 397

vascular drainage, 449–450, 449f, 450f

Cavernous sinus syndrome, 400–404causes, 401–404

CCF. See Carotid cavernous fistulaCentral core myopathy, 357Central nervous system (CNS)

angiopathies, associated with ocular manifestations, 527, 528t–529t

toxicity, and binocular visual loss, 126, 132

vasculitis, 545–547, 546fCentral retinal artery, 136, 136f, 137f

emboli in, 137f, 138, 140occlusion, 136, 145, 146–147, 146f,

147fvasospasm, and transient monocular

visual loss, 141

Index 589

Central retinal vein occlusion, 155–159, 155f, 239

acute, 156, 159fand disk edema, 242fshunt vessel development with, 159,

159fand transient monocular visual loss,

142, 142fCerebellar degeneration, 473f

and periodic alternating nystagmus, 472

Cerebellum, veins of, 532, 532fCerebral anoxia, and binocular visual

loss, 126Cerebral autosomal dominant

arteriopathy with subcortical infarcts and leukoencephalopathy. See CADASIL

Cerebral blindness, 131, 132, 268Cerebral degenerations of childhood,

and optic neuropathy, 217Cerebral diplopia, 266Cerebral infarction. See also Stroke

causes, 521, 521fcomputed tomography of, 89, 90f,

519, 520fparamedian, 427, 428fprevention, 153

Cerebral ischemialesions, 571mechanisms, 521, 521f

Cerebral vasculopathy, 545Cerebral venous thrombosis, 247, 248f,

530–533and binocular visual loss, 126in cancer patient, 569clinical presentation, 532, 533diagnosis, 533, 533f, 534f

Cerebrospinal fluid (CSF)analysis, 375. See also Lumbar

puncturein HIV-infected (AIDS) patients, 191in optic neuropathy, 182

circulation, 247f, 530, 531fCerebrovascular disease, 519–544Cervical artery dissections, 522, 523f, 524fChalazion, ptosis caused by, 489, 490fCharcot-Marie-Tooth disease, and optic

neuropathy, 217Charles Bonnet syndrome, 262Chemosis, 17fCherry red spot, 145, 146f

in giant cell arteritis, 151fChiari malformation(s)

neurologic and ocular involvement in, 470, 471f, 472, 581–582, 581f

and sixth nerve palsy, 371, 372, 372f

Chiasmlesions

postoperative, 571topographic diagnosis, 60, 60f, 61f

neoplasms affecting, 213t–214tChiasmal syndrome, magnetic

resonance imaging of, 96Child(ren). See also Cerebral

degenerations of childhood; Mitochondrial disease

compressive/infiltrative optic neuropathy in, 209

fourth nerve palsies in, 382Horner syndrome in, 292–294magnetic resonance angiography in,

294magnetic resonance imaging in, 294with nystagmus, 463, 465t, 466–468,

467foptic neuritis in, 192patching in, 441sixth nerve palsies in, 373third nerve palsies in, 395

Cholesterol emboli, 39f, 140fasymptomatic, 145, 145fcharacteristics, 150t

Choroidblood supply to, 136, 137fneovascular membrane in, 40f

Choroidal artery(ies), infarction, homonymous hemianopia caused by, 67f

Choroidal ischemia, in giant cell arteritis, 151, 549, 550

Christmas tree cataracts, 355, 356fChronic progressive external

ophthalmoplegianeurologic and ocular involvement in,

353–356, 353f, 354f, 579tand optic neuropathy, 218ptosis with, 488, 490, 490f, 491f

Churg-Strauss syndrome, and arteritic ischemic optic neuropathy, 205

Ciliary body, blood supply to, 136, 137fCilioretinal artery, 147, 147f

occlusion, 551Circle of Willis, 131, 131f

on catheter angiogram, 104, 105fCT angiography of, 99fmagnetic resonance angiography of,

101fCircle of Zinn, 137fClaude syndrome, lesion location in,

440tCluster headache, 517tCluster of grapes appearance, 171fCME. See Cystoid macular edema

590 Index

Coagulopathy(ies). See also Hypercoagulable disorder(s)/state(s)

mimicking cerebral angiitis, 547Cocaine

in diagnosis of Horner syndrome, 285–286, 286f

hallucinations/illusions caused by, 268

Cogan lid twitch sign. See MyastheniaCollier sign, 422f, 425f, 494, 496, 496fColoboma

iris, anisocoria caused by, 283optic disk, 232, 232f

Color perception, cortical pathway for, 256

Color plates, 4, 4f, 26tColor saturation, testing, 4, 5f, 26tColor vision

changes in, 107testing, 4, 4f, 26t

Comacauses, 23eye movements in

examination, 336and localization of brain lesions,

23pupillary abnormalities in, 278, 278f

Comatose patient, neuro-ophthalmic examination of, 23–25

Commotio retina, 40fComputed tomography (CT). See also CT

angiography; CT venographyof carotid cavernous fistula, 457, 457fof cerebral infarction, 519, 520fin compressive optic neuropathy, 207contrast-enhanced, 89tin degenerative dementias, 259in headache/facial pain, 518indications for, 89of intracranial hemorrhage, 519, 520f,

536, 536fin orbital syndrome, 447–448of orbits and visual pathways, 89, 89t,

90f, 91fadvantages and disadvantages, 88t

with papilledema, 248of subarachnoid hemorrhage, 540ftissue density on, 89t

Cone dystrophy(ies), 122, 123, 123fConfrontation visual field testing, 45,

46fin nonorganic visual field

constriction, 506–507, 506fConfusion, hallucinations/illusions

caused by, 263Congenital familial fibrosis, 357Consensual (pupillary) response, 270

Contrast sensitivity, testing, 5Convergence

evaluation, 319, 320fnear point of, measurement, 418, 418f

Convergence insufficiency, 418Convergence-retraction nystagmus, 18,

477, 478fConvergence spasm, 305, 305f, 374,

374f, 417, 418f, 508, 508fCorneal reflex, in comatose patient, 25Corneal ulcer, 111fCotton wool spots, 37f, 39f, 156

in Purtscher retinopathy, 169, 169fin radiation retinopathy, 168, 168fin retinal vasculitis, 165f, 166

Cover-uncover test, 319–321, 321fCPEO. See Chronic progressive external

ophthalmoplegiaCranial arteritis. See Giant cell arteritisCranial nerve(s)

III, 315. See also Third nerve palsy(ies)aberrant regeneration, 395, 396,

396fanatomy, 383, 384flesions, and ptosis, 493, 493fnucleus

anatomy, 385lesions, 385–388, 385f–388f

palsy, 348IV. See also Fourth nerve palsy(ies)

anatomy, 377–378, 378fpalsy, 348schwannoma, 379, 380f

VI. See also Sixth nerve palsy(ies)anatomy, 365, 366fnucleus, 410

lesions, 411–412, 412f, 413fpalsy, 348

VII, 365, 366. See also Seventh nerve palsy(ies)

deficit, magnetic resonance imaging of, 96

multiple, lesions involving, 397–410palsy, and diplopia, 348systemic disorders involving, 397trauma, and diplopia, 348

Cranial neuralgia(s), 515Craniopharyngioma

clinical features, 214tand compressive optic neuropathy,

207, 212fCreutzfeldt-Jakob disease (CJD), 256,

260and binocular visual loss, 126hallucinations/illusions in, 263palinopsia caused by, 266

Cross-cover test, 321–324, 322f–324fthree-step, 324, 324f

Index 591

Cryptococcosis, 563, 564foptic neuritis associated with, 184,

189CTA. See CT angiographyCT angiography, 98, 99f, 102, 375

of cavernous sinus aneurysm, 452fCTV. See CT venographyCT venography, 98, 100fCup-to-disk ratio, 31, 31f, 196, 196f, 199,

212fCyclosporine, CNS toxicity, and

binocular visual loss, 126, 132Cyclotorsion, Maddox rod test for, 334,

334fCystoid macular edema, 82f, 121, 121fCytomegalovirus (CMV) infection

optic neuritis associated with, 184, 189, 191f

and retinal vasculitis, 167, 167fretinitis, in HIV-infected (AIDS)

patients, 565, 565f

DDeafness. See Autosomal dominant

progressive optic atrophy and deafness; Autosomal dominant progressive optic atrophy with progressive hearing loss and ataxia; DIDMOAD; Hereditary optic atrophy with progressive hearing loss and polyneuropathy; Sex-linked recessive optic atrophy, ataxia, deafness, tetraplegia, and areflexia

Degenerative disorders, and binocular visual loss, 126

Delirium, postoperative, 268Delirium tremens, hallucinations

caused by, 263Dementia(s). See also Alzheimer

diseasedegenerative, 259–260hallucinations/illusions caused by,

263de Morsier syndrome. See Septo-optic

dysplasiaDemyelinating disease. See Multiple

Sclerosis and Neuromyletis optica

Dermatochalasis, 488, 489with pseudoptosis, 493, 494f

Devic disease. See Neuromyletis opticaDiabetes insipidus. See DIDMOADDiabetes mellitus. See also DIDMOAD

Argyll Robertson pupils in, 303and optic neuropathy, 181t

and orbital apex syndrome, 398, 399f, 400

orbital apex syndrome in, 178Diabetic papillopathy, 199, 199f, 239Diabetic retinopathy, 160–161, 160f–161f

nonproliferative, 36f, 160fproliferative, 160–161, 160f

DIDMOAD, 181t, 217Digoxin, hallucinations/illusions caused

by, 268Diplopia, 306–442

after ocular surgery, 433assessment, 433–434, 434fbinocular, 307

diagnosis, 337–433evaluation of patient with, practical

tips, 433–439with internuclear lesion, 410–432with lesion at neuromuscular

junction, 357–364with lesion involving multiple

cranial nerves, 397–410with lesion of cranial nerve, 365–397with lesion of extraocular muscles,

337–357localization of lesion causing, 439,

440tnonorganic, 508pearls, 439with supranuclear lesion, 410–432

evaluation of patient with. See also Eye movements, examination

goals, 337pearls, 337practical tips, 433–439

monocular, 306–307nonorganic, 507

pearls, 435postoperative, 571posttraumatic, 570treatment, 441–442

Direct (pupillary) response, 270Disk-at-risk, in anterior ischemic optic

neuropathy, 196, 196f, 198f, 199

Disk edema, 237–255bilateral, in comatose patient, 25diagnosis, decision tree for, 249fdifferential diagnosis, 239–240,

240f–243fevaluation of patient with, 244–248mechanisms of, 237optic neuropathy with, and

papilledema, comparison, 244, 244t

and pseudoedema, differentiation, 238, 238f, 238t, 239f

Distance vision, testing, 2, 2f, 26t

592 Index

Disulfiram, optic neuropathy caused by, 221

Divergence insufficiency, 419Dix-Hallpike maneuver, 466t, 469,

469fDOA. See Dominant optic atrophyDominant optic atrophy, neurologic and

ocular involvement in, 181t, 217, 220–221, 220f, 579t

Dorsal midbrain syndrome, 18, 422f, 424, 424f, 425, 425f, 440t

convergence-retraction nystagmus in, 477, 478f

eyelid retraction in, 494, 496, 496fDouble Maddox rod test, 334, 334fDownbeat nystagmus, 470, 470t, 471fDowngaze paresis, 427, 427f, 428fDrug(s)

antiparkinsonian, hallucinations caused by, 263, 268

hallucinations/illusions caused by, 268

myasthenic syndrome caused by, 361mydriasis caused by, 294–295, 295t,

296fpalinopsia caused by, 265periodic alternating nystagmus

caused by, 472Drusen, 40f

macular, 119, 119foptic nerve head, 180, 228–229,

228f–229f, 240fand anterior ischemic optic

neuropathy, 200, 202, 202fB-scan echography of, 86, 86fincidentally discovered, 229

Duane syndrome, 372, 373fclinical characteristics, 372and optic nerve hypoplasia, 230types, 372, 373f

Duction(s), definition, 17Dysmegalopsia, 266Dysmetropsia, 266

EEchography, ocular/orbital, 85–86, 86f,

87fA-scan, 85B-scan, 85–86, 86f, 87f, 113, 115f

Eclampsiaand binocular visual loss, 126, 132and hypertensive retinopathy, 37f

Ecstasy, hallucinations/illusions caused by, 268

Edinger-Westphal nucleus, 272–273, 273f, 275, 384f, 385, 424

Edrophonium (Tensilon) test, 362, 362f

Ehlers-Danlos syndrome, 529tElectrocardiography, indications for,

220Electronystagmography (ENG), 466Electrophysiologic testing, 76–80

in optic neuropathy, 175Electroretinography (ERG), 78–80, 117,

123full-field, 79, 79fmultifocal, 79, 80fin optic neuropathy, 175

Emboli, into retinal circulation, 138, 139f, 140f, 146, 147f, 148, 150t

asymptomatic, 145, 145fcardiac sources, 152t

Embolismcardiac, mimicking cerebral angiitis,

547cardiac sources of, and embolic risk,

524–525Encephalofacial angiomatosis. See

Sturge-Weber syndromeEncephalopathy(ies)

abnormal visual perceptions in, 263–268

palinopsia caused by, 266Encephalotrigeminal angiomatosis. See

Sturge-Weber syndromeENG. See Electronystagmography (ENG)Enophthalmos, 9

with orbital metastases of breast cancer, 447, 447f

Entoptic phenomena, 261Environment tilt, 267, 267fEpidural hemorrhage, 534, 535fEpiretinal membrane

and macropsia, 261optical coherence tomography, 84

Erectile dysfunction medications, vision changes caused by, 268

ERG. See Electroretinography (ERG)Esotropia, 321, 321f, 433

thalamic, 373, 374fEthambutol, optic neuropathy caused

by, 221, 222, 222fEthylene glycol, optic neuropathy

caused by, 221Exotropia, 321, 321f, 433External carotid artery(ies) (ECA), 136

and blood supply to orbit, 138, 139fbranches, 138, 138f

disorders, 155pearls, 138

Extraocular musclesagenesis, 356botulinum toxin injection in, for

diplopia, 442congenital adherence, 357

Index 593

congenital/developmental disorders affecting, 356–357

disorders, 337–357and restriction, 337, 338fand weakness (paresis), 337

enlargeddifferential diagnosis, 339pearls, 339

inflammation (myositis), 343–346metastatic disease and, 346–347, 347forbital tumors and, 346–347, 348forigin and insertion, anomalies,

356–357progressive myopathies affecting,

353–356Exudate(s), yellow, 36f, 37fEye(s)

anatomy, 109fblood supply to, 135, 135f, 136, 137fhypoperfusion, 140–141, 141f

Eyelid(s)anatomy, 482, 483f, 484f, 485fexamination, 8, 8f, 9f, 26t, 486

pearls, 490external appearance, 483fincomplete closure, 482, 497–499, 497f

complications, 498, 498fmanagement, 498–499, 498f, 499f

inversion, 490lesions, ptosis caused by, 488, 489,

489fmuscles, 482opening, apraxia of, 488, 493palpation, 490retraction, 494–497

causes, 494contralateral ptosis and, 494, 497,

497fdefinition, 482in dorsal midbrain syndrome, 494,

496, 496fmechanical, 494myogenic, 494neurogenic, 494in thyroid eye disease, 494, 495,

495f, 496fEye movements, 308–313

in comatose patient, 24–25and localization of brain lesions, 23roving, 24

downward, control of, 420–421, 420f, 421f

examination, 314–337in comatose patient, 336results, communicating, 326, 326f,

327fin uncooperative patients, 336in young children, 336

horizontalabnormalities, 411–419control of, 410–411, 411f

nystagmoid, 477–479. See also Nystagmus

smooth pursuit, 431. See also Pursuittranscription of, 326, 326f, 327fupward, control of, 420–421, 420f, 421fvertical

abnormalities, 422–429control of, 420–421, 420f, 421f

FFabry disease, 528tFacial colliculus syndrome, 366Facial nerve. See Cranial nerve(s), VII;

Seventh nerve palsy(ies)Facial pain

central, 515classification, 513–515clinical diagnosis, 511–512, 511fdifferential diagnosis, 516, 517tevaluation of patient with, 512, 513fmode of onset, 511, 511f, 518primary, 515secondary, 514

work-up for, 518temporal profile, 511, 511f, 518

Facial weakness, 482, 497–499Familial dysautonomia, and optic

neuropathy, 217Fat emboli, 39f

characteristics, 150tFetal alcohol syndrome, and optic nerve

hypoplasia, 230Fibromuscular dysplasia, 529tFibrous dysplasia

and compressive optic neuropathy, 207and orbital bony deformations, 350,

350fFinger confrontation test, 45, 46fFK-506. See TacrolimusFlashing lights, 262Floaters, 262Fluorescein angiography, 81–83, 81f–83f

of cystoid macular edema, 121, 121findications for, 117in retinal vasculitis, 166, 166f

Focal cerebral lesions, palinopsia caused by, 265

Folate deficiency, optic neuropathy caused by, 221

Forced duction test, 317, 317f, 337Foreign body(ies), intraocular, B-scan

echography of, 86Fortification spectrum, migraine and,

516

594 Index

Fourth nerve palsy(ies), 375–382, 375f, 376f, 435, 435f

acquired, causes, 378–379, 379tin children, 382congenital, 380, 381fwith contralateral Horner syndrome,

lesion location in, 440tevaluation of patient for, 382and Horner syndrome, 291, 378microvascular, 379pearls, 376, 379schwannoma and, 379, 380f

Friedreich ataxia, 217Fundus

examinationindications for, 40in patient with diplopia, 436–438

normal, 20f, 31fobstructed view of, 33–35

Funduscopic examination, 20, 20f–22f, 25–40, 27t

in comatose patient, 25in patient with visual loss, 110, 112fpearls, 32, 114

Fungal infectioncerebral angiitis associated with, 546optic neuritis associated with, 184

GGallium scan, in sarcoidosis, 562, 562fGanglion cell fibers, optic tract lesion

and, 65, 66fGaze

conjugate vertical, anatomy of, 420–421, 420f

horizontal conjugate, abnormal deviations, 419, 419f

periodic alternating (“ping-pong”), in comatose patient, 24

Gaze-evoked nystagmus, 468, 469fGeneral anesthesia, hallucinations after,

268General examination, 23, 27tGerminoma, clinical features, 214tGerstmann syndrome, 259, 260Giant cell arteritis, 151, 151f, 513, 513f,

548–553clinical manifestations, 548, 552

neuro-ophthalmic, 549–550nonneuro-ophthalmic, 549

diagnosis, 142, 548, 552rheumatologic criteria for, 552

and diplopia, 349, 350, 370, 371f, 548, 549

evaluation of patients with, 152t, 548fluorescein angiography in, 83, 83f,

550, 551f

high risk for, ophthalmic signs suggesting, 551

and ischemic optic neuropathy, 195–196, 204, 205, 549–550

pearls, 151, 155, 204, 350, 370, 389, 548, 550, 552

and sixth nerve palsy, 370, 371fand third nerve palsy, 389and transient monocular visual loss,

141treatment, 553and visual loss, 549

Glasgow Coma Scale, 24, 24tGlaucoma, 58f, 237. See also Optic

neuropathy(ies), glaucomatouslow-tension, 227neovascular, 154, 154fand pupillary dilation, 32

Gliomaand infiltrative optic neuropathy,

240optic nerve

clinical features, 213tand infiltrative optic neuropathy,

207, 209proptosis caused by, 445, 446f

Goldmann (kinetic) perimetry, 47, 48f, 49f

in nonorganic visual field constriction, 506, 506f

Goldmann visual fields, 43fGraves disease. See Thyroid eye diseaseGroenblad-Strandberg syndrome. See

Pseudoxanthoma elasticumGuillain-Barré syndrome, 397, 409

HHallucination(s), 582. See also Abnormal

visual perception(s)in Charles Bonnet syndrome, 262definition, 261in narcolepsy, 265in neurologic disorders, 263–268in psychiatric disorders, 261

Headache. See also Cluster headache; Migraine

classification, 513–515clinical diagnosis, 511–512, 511fevaluation of patient with, 512, 513fand increased intracranial pressure,

246, 436mode of onset, 511, 511f, 518primary, 514secondary, 514

work-up for, 518with subarachnoid hemorrhage, 539temporal profile, 511, 511f, 518

Index 595

Head tiltassessment for, 434–435, 435fwith fourth nerve palsy, 435, 435f

Heerfordt syndrome, 559Hemangioma(s)

and compressive optic neuropathy, 239

intraorbital, and compressive optic neuropathy, 207

retinal, 171fHemeralopia, 123Hemianopia, and hemineglect,

differences between, 259, 259t

Hemichromatopsia, 257tHemicrania, 516

paroxysmal, episodic or chronic, 517tHemicrania continua, 517tHemifacial spasm, 499

treatment, 500Hemineglect, 256, 258t, 259

and hemianopia, differences between, 259, 259t

Hemiretinal vein occlusion, 157, 158fHemorrhage

cerebral. See also Intracranial hemorrhage; Stroke, hemorrhagic

computed tomography of, 89, 90frisk factors for, 537

in diabetic retinopathy, 160f, 161intraretinal, 36f, 37f, 38fmacular, 38f

in Terson syndrome, 541–542, 541forbital, and compressive optic

neuropathy, 207peripapillary, in Terson syndrome,

541–542, 541fretinal, 146f, 147f

with central retinal vein occlusion, 156, 159f

in radiation retinopathy, 168, 168fin retinal vasculitis, 165f, 166

subconjunctival, 283fsubhyaloid, 38ftemporal, 68fthalamic, 426, 426fvitreous, 38f, 115f

B-scan echography of, 86, 87fin comatose patient, 25and red reflex, 35, 35fin Terson syndrome, 541–542,

541fHepatic encephalopathy

and binocular visual loss, 126palinopsia caused by, 266and periodic alternating nystagmus,

472

Hepatitis Bvaccine, optic neuritis associated

with, 184Hepatolenticular degeneration. See

Wilson diseaseHereditary cerebral amyloid

angiopathy, 529tHereditary hemorrhagic telangiectasia

(HHT), 528tHereditary muscular dystrophy, and

optic neuropathy, 217Hereditary optic atrophy with

progressive hearing loss and polyneuropathy, 217

Hereditary spastic paraplegias, and optic neuropathy, 217

Herpes simplexoptic neuritis associated with, 184and retinal vasculitis, 167

Herpes zosterand multiple cranial nerve

involvement, 397neurologic and ocular involvement in,

563, 566foptic neuritis associated with, 184and retinal vasculitis, 167, 167ftrigeminal nerve involvement in, 406,

406fHertel exophthalmometer, 9, 10fHeterochromia, congenital, anisocoria

caused by, 283, 284, 285fHeterophoria, definition, 315Heterotropia, definition, 315HGPPS. See Horizontal gaze paresis and

progressive scoliosisHigher cortical areas, 256Higher cortical function, disorders,

256–260causes, 259–260classification, 256clinical characteristics, 256–260,

257t–258tradiologic findings in, 256–260,

257t–258tHippus, 271Hirschberg test, 335, 335fHomocystinemia, 528tHomocystinuria, 528tHomonymous hemianopia, 61, 62f–64f

bilateral, 74, 74f, 75fcomplete, 61, 62fcongruent, 61, 63fGoldmann visual field test showing,

49fHumphrey visual field test showing,

51fincomplete, 61, 63f, 64fincongruent, 61, 64f

596 Index

Homonymous hemianopia, (cont.)lateral geniculate nucleus lesions and,

67, 67fwith macular sparing, 71foptic radiations and, 68, 68f, 69foptic tract lesions and, 65, 65f, 67sparing temporal crescent, 73, 73ftransient, 129

Horizontal conjugate gaze deviations, abnormal, 419, 419f

Horizontal gaze, anatomy, 410–411, 411f

Horizontal gaze paresis, 411–412, 412f, 413f

with ipsilateral facial palsy, lesion location in, 440t

Horizontal gaze paresis and progressive scoliosis, 373

Horner syndrome, 284–294in adults, 289–292

causes, 290tcentral (first order), 289, 289f,

290tand fourth nerve palsy, 291, 378

evaluation of patient with, 292pearls, 291postganglionic (third order), 288f,

289, 290f, 290tand sixth nerve palsy, 291, 291f

preganglionic (second order), 288f, 289, 289f, 290t

associated signs and symptoms, 284clinical features, 284, 285fcongenital, with heterochromia, 284,

285fdiagnosis, 285–287, 286f, 287fin infants and children, 292–294

causes, 292, 293tevaluation of patient, 294

localization of lesion causing, 287, 288f

and ptosis, 488, 492, 492ftreatment, 294

Horton disease. See Giant cell arteritisHuman immunodeficiency virus

(HIV). See also Acquired immunodeficiency syndrome

dementia, hallucinations/illusions in, 263

optic neuritis associated with, 184, 189–191, 191f

Human transmissible spongiform encephalopathy(ies), 260

Humphrey visual field printout, 50, 51f, 52, 52f

Huntington disease, hallucinations/illusions in, 263

Hydrocephalus, 245, 245fobstructive, 425, 425f

Hydroxyamphetamine test, for localization of Horner syndrome, 287, 288f

Hypercoagulable disorder(s)/state(s), 526–527

cancer-induced, 569evaluation of patients with, 152t

Hyperglycemia, palinopsia caused by, 266

Hypertensionmalignant systemic, 239

and disk edema, 242fvisual loss caused by, 126, 127f

and optic neuropathy, 181tHypertensive encephalopathy, 75f

and binocular visual loss, 126, 132Hypertensive retinopathy, 37f, 162–164,

162f–164facute, 164, 164f

clinical features, 164clinical features, 163–164

Hypertropia, 9, 315, 321, 321fHyphema, traumatic, 112fHypoglobus, 352, 352fHypoglycemia

and binocular visual loss, 126palinopsia caused by, 266

Hypoperfusion (ocular), 140–141, 141f, 153–155

Hypotension, severe, and anterior ischemic optic neuropathy, 200, 201f

Hypotensive retinopathy, 153–155, 153f

Hypotropia, 9, 10f, 315, 321, 321f

IICE. See Iridocorneal-endothelial

syndromeIdiopathic intracranial hypertension,

252–255, 254f, 255fdiagnostic criteria for, 252management, 252–255, 254f, 255f

IIH. See Idiopathic intracranial hypertension

Illusion(s). See also Abnormal visual perception(s)

definition, 261in neurologic disorders, 263–268in psychiatric disorders, 261

Imaging. See also specific imaging modality

of carotid cavernous fistula, 457, 457f, 458f

Index 597

of cerebral venous thrombosis, 533, 533f, 534f

in compressive optic neuropathy, 207of intraparenchymal hemorrhage,

537, 537fin optic neuropathy, 182in orbital syndrome, 447–448of orbits and visual pathways, 88–97with papilledema, 248vascular, 97–106

Infection(s)and binocular visual loss, 126cerebral angiitis associated with,

546mimicking cerebral angiitis, 547pearls, 563and retinal vasculitis, 167systemic

neurologic and ocular involvement in, 563–567

optic neuropathy in, 180Infectious emboli, characteristics, 150tInfectious keratitis, 111fInflammation

idiopathic orbital. See Orbital pseudotumor

intraocular, anisocoria caused by, 283

orbital, 436, 436fcomputed tomography of, 89, 91f

Inflammatory disordersand retinal vasculitis, 167systemic, optic neuropathy in, 180

Inflammatory pseudotumor, orbital, 17f, 240

INO. See Internuclear ophthalmoplegiaInternal carotid artery(ies) (ICA), 130,

130f, 135, 136faneurysm, 540faneurysm, on catheter angiogram,

105fbifurcation, aneurysm, clinical

manifestations, 543tcongenital agenesis, 293fdissection, 522, 523f, 524f

and Horner syndrome, 290f, 291, 522, 523f, 524f

ectatic, and compressive optic neuropathy, 207

stenosis, 149fInternuclear ocular motor disorders,

410–432Internuclear ophthalmoplegia, 18

bilateral, 414–415, 515fcauses, 417and dissociated jerk nystagmus, 474,

474f

pearls, 417unilateral, 413, 413f, 414f

Intracranial hemorrhage, 534–544. See also Epidural hemorrhage; Intraparenchymal hemorrhage; Subarachnoid hemorrhage; Subdural hemorrhage

classification, 534–536, 535fIntracranial mass(es), 245, 245fIntracranial pressure

increased, 180, 512, 513, 513f. See also Idiopathic intracranial hypertension; Papilledema

in cancer patient, 568–569and diplopia, 348mechanisms, 245pearls, 246and sixth nerve palsy, 371, 371f

venous, increased, 246, 247fIntraocular hypotony, 240Intraparenchymal hemorrhage, 536,

536fimaging, 537, 537frisk factors for, 537

Iopidine. See ApraclonidineIridocorneal-endothelial syndrome,

anisocoria caused by, 283Iris

blood supply to, 136, 137fcoloboma, anisocoria caused by, 283dilator muscle, innervation, 277nevus, 281fnormal, 272fstructural defects, anisocoria caused

by, 283traumatic tears, 282f, 283f

Ischemic ocular syndrome, 141, 141fIschemic optic neuropathy, 180,

194–206anterior. See Anterior ischemic optic

neuropathyarteritic, 180, 195–196, 204–206, 549

associated disorders, 205causes, 205characteristics, 205diagnosis, 205pearls, 549treatment, 206

classification, 195–196clinical anatomy, 194, 194fnonarteritic, 180, 195–196pearls, 195, 196, 204posterior. See Posterior ischemic optic

neuropathypostoperative, 571work-up for, 195, 196

Ishihara color plates, 4, 4f, 26t

598 Index

JJerk nystagmus

clinical characteristics, 463, 463tdefinition, 463localizing, 470, 470twaveforms of, 464, 464f

KKayser-Fleischer ring, 583–584, 584fKearns-Sayre syndrome

and chronic progressive external ophthalmoplegia, 355

neurologic and ocular involvement in, 579t

and optic neuropathy, 218Keratoconus, 111fKeratoprecipitates, 16fKjer optic atrophy (Kjer disease). See

Dominant optic atrophyKlippel-Trenaunay-Weber syndrome,

neurologic and ocular involvement in, 578

Krimsky test, 335, 336f

LLateral geniculate nucleus, lesions, 67,

67fLateral medullary syndrome, and

environment tilt, 267Lead, optic neuropathy caused by, 221Leber hereditary optic neuropathy,

neurologic and ocular involvement in, 181t, 217, 218–220, 218f–219f, 239, 579t

Leigh syndrome, neurologic and ocular involvement in, 218, 355, 580t

Leukemia(s), and infiltrative optic neuropathy, 207, 216f, 240

Leukocoria, 113f, 114Levator function, evaluation, 8, 9f, 26t,

486, 486fLewy body dementia, hallucinations

caused by, 263, 582Lhermitte sign, 554LHON. See Leber hereditary optic

neuropathyLid(s). See Eyelid(s)Light-near dissociation, 275, 275f, 276f,

303causes, 304t

Light-reflex pathways, 275–276Linezolid, optic neuropathy caused by,

221Lisch nodules, 572, 572fLocked-in syndrome, 432

Long posterior ciliary artery(ies), 136, 136f, 137f, 194, 194f

Louis-Bar syndrome. See Ataxia-telangiectasia (AT)

LSD. See Lysergic acid diethylamide (LSD)

Lumbar puncture, 375in headache/facial pain, 518in HIV-infected (AIDS) patients, 191in idiopathic demyelinating optic

neuritis, 185in optic neuritis, 183in optic neuropathy, 182with papilledema, 248, 533

Luxury perfusion, in anterior ischemic optic neuropathy, 197, 199f

Lyme disease, optic neuritis associated with, 184, 192

Lymphangiomaand compressive optic neuropathy,

239intraorbital, and compressive optic

neuropathy, 207Lymphoma(s), and infiltrative optic

neuropathy, 207, 215, 240Lysergic acid diethylamide (LSD)

hallucinations/illusions caused by, 268

maternal use of, and optic nerve hypoplasia, 230

palinopsia caused by, 265

MMacropsia, 261, 266

migraine and, 264Macrosquare-wave jerks, 480Macula

leakage at, fluorescein angiography, 82f

lesions, clinical characteristics, 117, 118t

Macular cyst, optical coherence tomography, 84

Macular degeneration, 119, 119fMacular edema

and micropsia, 261optical coherence tomography, 84, 84f

Macular hole, 55f, 120, 120foptical coherence tomography, 84, 84f

Macular star, 193fMacular traction, optical coherence

tomography, 84Maculopathy(ies)

and abnormal visual perceptions, 261–262, 262f

bull’s-eye, 123, 123fclinical characteristics, 117, 118t

Index 599

clinical presentation, 180differentiation from optic nerve

disease, 180, 182tMaddox rod test, 330–334, 331f

for cyclotorsion, 334, 334fdouble, 334, 334ffor horizontal and vertical deviation,

331–333, 331f–333fand prism quantification, 326

Magnetic resonance angiography (MRA), 96, 100–102, 101f, 102f, 375

of carotid cavernous fistula, 457, 457fin children, 294in headache/facial pain, 518

Magnetic resonance imaging (MRI), 176f, 179f, 182

apparent diffusion coefficient (ADC) map, 95f, 96, 96f

of carotid cavernous fistula, 457, 457fin children, 294CINE technique, for Chiari

malformation, 582in compressive optic neuropathy,

207contrast-enhanced, 93, 93f, 94f, 96in degenerative dementias, 259diffusion-weighted sequences, 95f,

96, 96ffluid-attenuated inversion recovery

(FLAIR) sequence, 94, 95f, 96, 127f

gradient echo sequence, 94, 96in headache/facial pain, 518with hemifacial spasm, 499in idiopathic demyelinating optic

neuritis, 185–187, 186fof intraparenchymal hemorrhage,

537, 537fin ischemic optic neuropathy, 196in multiple sclerosis, 185–187, 186f,

556fin optic nerve hypoplasia, 230in optic neuritis, 183in orbital syndrome, 447–448of orbits and visual pathways, 92–97,

92f–96fadvantages and disadvantages,

88t, 92indications for, 97

with papilledema, 248in peduncular hallucinosis, 265fwith sixth nerve palsy, 375tissue intensities on, 92, 94T1 sequence with fat suppression, 93,

93f, 94fT1-weighted, 92, 92f, 96T2-weighted, 94–96, 95f, 96f

Magnetic resonance venography (MRV), 100–102

of cerebral venous thrombosis, 533, 533f, 534f

in headache/facial pain, 518Malignancy, and optic neuropathy, 181tMAR. See Melanoma-associated

retinopathyMarcus Gunn jaw winking, 487, 488fMarcus Gunn pupil. See Relative

afferent pupillary defectMarfan syndrome, 529tMargin reflex distance, measurement, 8,

8f, 26t, 486, 486fMarijuana, hallucinations/illusions

caused by, 268Maternally inherited diabetes

mellitus and deafness. See MIDD

Measles, mumps, and rubella (MMR) vaccine, optic neuritis associated with, 184

Media, opacity, 113, 114factors affecting, 33and view of fundus, 33, 33f

Meige syndrome, 500Melanoma-associated retinopathy, 124MELAS

and chronic progressive external ophthalmoplegia, 355

neurologic and ocular involvement in, 525, 528t, 547, 579t–580t

and optic neuropathy, 218Meningeal carcinomatosis. See also

Carcinomatous meningitisand infiltrative optic neuropathy, 207

Meningeal process, and multiple cranial nerve involvement, 397

Meningioma, 69fcavernous sinus, 401, 401fand compressive optic neuropathy, 239optic nerve sheath

clinical features, 213tand compressive optic neuropathy,

207, 208f, 209, 209fand disk edema, 243f

sphenoidclinical features, 213tand compressive optic neuropathy,

207Meningitis

and binocular visual loss, 126carcinomatous, 568–569cryptococcal, 563, 564finfectious, 563

pearls, 563optic neuritis associated with, 184

Menkes syndrome, 529t

600 Index

Mercury, CNS toxicity, and binocular visual loss, 126

MERRF, neurologic and ocular involvement in, 218, 580t

Metabolic disordersand binocular visual loss, 126and disk edema, 240mimicking cerebral angiitis, 547

Metamorphopsia, 6, 261, 266Metastatic disease

clinical features, 214tand compressive/infiltrative optic

neuropathy, 207, 215fcomputed tomography of, 91fextraocular muscle involvement in,

346–347, 347fintraorbital, and compressive optic

neuropathy, 207, 215fMethanol, optic neuropathy caused by,

221MG. See Myasthenia gravis (MG)Microaneurysm(s), 36fMicropsia, 261, 266

migraine and, 264Midbrain correctopia, 303MIDD, neurologic and ocular

involvement in, 580tMiddle cerebral artery, 69, 70f

aneurysm, 540fclinical manifestations, 543t

on catheter angiogram, 103f, 105finfarction, 62f, 70magnetic resonance angiography of,

101fMigraine

with aura, diagnostic criteria for, 515–516

and binocular visual loss, 126, 128, 129fcharacteristics, 515and environment tilt, 267, 267fpearls, 516treatment, 516visual phenomena accompanying,

263–264, 263t, 264f, 516. See also Aura

without aura, diagnostic criteria for, 515

Miller-Fisher syndrome, 397, 406–409, 409f

Miller-Gubler syndrome, lesion location in, 440t

MINGIE syndrome, neurologic and ocular involvement in, 355, 580t

Miosis, 272f, 284–294. See also Pupillary constriction

Mirror test, for nonorganic blindness, 504–505, 505f

Mitochondrial disease(s)neurologic and ocular involvement in,

578, 579t–580tand optic neuropathy, 181t, 218pearls, 220

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes. See MELAS

Mitochondrial myopathy(ies), and chronic progressive external ophthalmoplegia, 353–355

Mitochondrial neurogastrointestinal encephalomyopathy. See MINGIE syndrome

Möbius syndrome, 373Mollaret triangle, 476, 476fMorning glory disk anomaly, 233,

233fMoyamoya disease, 529tMRA. See Magnetic resonance

angiography (MRA)MRI. See Magnetic resonance imaging

(MRI)MRV. See Magnetic resonance

venography (MRV)MS. See Multiple sclerosis (MS)Mucormycosis

optic neuritis associated with, 184and orbital apex syndrome, 398, 399f,

400Müller muscle(s), 482

innervation, 277Multicore myopathy, 357Multi-infarct dementia, hallucinations/

illusions in, 263Multiple evanescent white dot

syndrome, 262Multiple sclerosis (MS), 554–558

acquired pendular nystagmus in, 474

clinical course, 557diagnosis, 557diagnostic criteria for, 2005 revised

McDonald, 557, 558tidiopathic demyelinating optic

neuritis in, 180and internuclear ophthalmoplegia,

415, 415finternuclear ophthalmoplegia in, and

dissociated jerk nystagmus, 474, 474f

neuro-ophthalmic manifestations, 554–556, 555f

and optic neuritis, 184–187, 186f, 554, 555, 555f–556f

optic tract lesion in, 66fpearls, 415, 554

Index 601

and periodic alternating nystagmus, 472

retinal vasculitis in, 166, 167signs and symptoms, 554

Muscular dystrophy, hereditary, and optic neuropathy, 217

Myastheniacongenital (neonatal), 487ocular, 357–363

clinical presentation, 358–360, 358f, 359f

evaluation of patient for, 361–362pearls, 361, 397thyroid eye disease associated with,

363, 364fMyasthenia gravis (MG), 357–363

causes, 361clinical presentation, 360, 360f, 361pearls, 361, 491ptosis in, 488, 491, 491ftreatment, 363

Myasthenic syndrome, 361Mydriasis, 272f, 294–301, 438. See

also Adie pupil; Pupillary dilation

benign episodic pupillary, 304bilateral, 304causes, 294–301

ocular, 294dysfunction of ipsilateral

parasympathetic pathway and, 296–301

pharmacologic, 294–295, 295t, 296f, 508, 509f

third nerve palsy and, 299–301, 299f, 300f

pearls, 301traumatic, 294

Myelinated nerve fibers, retinal, 236, 236f, 239, 240f

Myoclonic epilepsy and ragged red fibers. See MERRF

Myopathy(ies). See also Mitochondrial myopathy(ies)

congenital, affecting extraocular muscles, 357

progressive, affecting extraocular muscles, 353–356

Myopia, high, ocular motility deficits in, 432

Myositisof extraocular muscles, 343–346

clinical presentation, 343infectious, 343noninfectious, 344–346, 345fpearls, 347

of superior oblique muscle/tendon, 346

Myotonic dystrophy, 355, 356fMyotubular myopathy, 357

NNarcolepsy, 265NARP, neurologic and ocular

involvement in, 580tNasopharyngeal carcinoma, and

infiltrative optic neuropathy, 207

Near-reflex pathways, 275–276Near triad, 319

spasm of, 305, 305f, 374, 374f, 417, 418f, 508, 508f

Near vision, testing, 3, 3f, 26tNemaline myopathy, 357Neoplastic emboli, characteristics, 150tNeovascularization

anisocoria caused by, 283in diabetic retinopathy, 160–161,

160fin ocular ischemic syndrome, 154,

154fNeuroblastoma

and Horner syndrome, 293f, 294metastatic, 293f

Neurofibromatosis (NF)and optic neuropathy, 181ttype 1

and agenesis of sphenoid wing, 351, 574, 574f

neurologic and ocular involvement in, 528t, 572–573, 572f–574f

type 2, neurologic and ocular involvement in, 574, 574f

Neurogenic muscle weakness, ataxia, and retinitis pigmentosa, 580t

Neuroleptics, palinopsia caused by, 265Neurologic disorders, abnormal visual

perceptions in, 263–268Neuromuscular junction (NMJ). See

MyastheniaNeuromyelitis optica, 180, 187, 188f

antibodies, testing for, 183work-up for, 183

Neuromyotonia, ocular, 432Neuro-ophthalmic examination, 1–25

of comatose patient, 23–25summary, 26t–27ttools for, 1, 1t

Neuroretinitis, 192, 193f, 239Neurosarcoidosis, 179f, 559, 560fNevus, iris, 281fNF. See Neurofibromatosis (NF)Night blindness, congenital stationary,

303NMO. See Neuromyelitis optica

602 Index

Nonorganic symptoms and signs, 501–510

examination of patient with, 501–502management, 510pearls, 510types, 501

Nothnagel syndrome, lesion location in, 440t

Nutritionand disk edema, 240and optic neuropathy, 181t, 221, 223,

224fNystagmus, 463–477

acquired, 468–476characteristics, 463, 465t

acquired central, 470–476, 470tlocalizing, 470, 470t

Brun, 473, 474flocalizing, 470t

centralcharacteristics, 463, 465tand peripheral, differentiation

with Dix-Hallpike maneuver, 466t

in comatose patient, 24convergence-retraction, 18, 477,

478fdefinition, 463detection, 18dissociated jerk, 474, 474f

localizing, 470tdownbeat, 470, 471f

localizing, 470tevaluation of patient with, 466, 481fgaze-evoked, 468, 469finfantile (congenital)

characteristics, 463, 465t, 466–467, 467f

pearls, 467treatment, 468

jerk. See Jerk nystagmuslatent, 468management, 477monocular, localizing, 470toptokinetic, 18

testing for, 18, 18f, 19tin nonorganic visual loss,

504–505, 505fpathologic, 463pendular. See Pendular nystagmusperiodic alternating, 472, 472f

localizing, 470tperipheral

and central, differentiation with Dix-Hallpike maneuver, 466t

characteristics, 463, 465tphysiologic, 463with positional vertigo, 469, 469f

rebound, 473localizing, 470t

seesaw, 475, 475flocalizing, 470t

upbeat, 471, 471flocalizing, 470t

voluntary, 481, 508

OObject localization, cortical pathway

for, 256Object recognition, cortical pathway

for, 256Occipital lobe

arteriovenous malformation, 539fblood supply to, 69, 70f, 131, 131ffocal lesions, palinopsia caused by,

265infarction, 63f, 69, 71f, 72f, 73f, 74f

magnetic resonance imaging of, 95flesions

bilateral, 74, 74f, 75fand environment tilt, 267sparing temporal crescent, 73, 73funilateral, 69–70, 70f, 71f, 72f

Occipital mass, and binocular visual loss, 126

Occipital seizuresand binocular visual loss, 126, 131,

132tvisual phenomena accompanying,

263t, 264OCT. See Optical coherence

tomographyOcular apraxia, 256, 258tOcular bobbing, 479

in comatose patient, 24Ocular deviation

in comatose patientconjugate, 24dysconjugate, 24

horizontal and vertical, Maddox rod test for, 331–333, 331f–333f

quantification, 325–326, 325fOcular dipping, in comatose patient,

24Ocular disease(s), and transient

monocular visual loss, 110Ocular dysmetria, 481Ocular examination, 15–16, 26t

bedside, 16, 16f, 17fOcular flutter, 479–480, 480fOcular hypotony, 237Ocular infarction, prevention, 153Ocular ischemia

mechanisms, 521, 521fpostoperative, 571

Index 603

Ocular ischemic syndrome, 141, 141f, 153–155

clinical features, 153–154pearls, 155prognosis for, 155treatment, 154–155

Ocular misalignment, 314–315. See also Strabismus

assessment, 319–325primary deviation, 314quantification, 325–326, 325fsecondary deviation, 314surgery for, 442

Ocular motility. See also Eye movements

assessment, 316–319, 316f, 317fdeficits, in high myopia, 432examination, 17–19, 27t, 314–337terminology, 314–315

Ocular motor apraxiaacquired, 417congenital, 417

Ocular motor nerve, 315Ocular neuromyotonia, 432Ocular occlusion, 125Ocular oscillations. See also Nystagmus;

Saccadic intrusions (oscillations)

evaluation of patient with, 481fOcular tilt reaction, 429, 430fOculocephalic maneuvering, in

comatose patient, 25, 336Oculocephalic reflex, 336Oculocephalic responses, testing, 319,

320fOculomasticatory myorhythmia, 476

localizing, 470tOculomotor nerve, 315. See also Cranial

nerve(s), III; Third nerve palsy(ies)

Oculopalatal myoclonus, 476localizing, 470t

Oculopharyngeal dystrophy, 356Oculosympathetic paresis. See Horner

syndromeOculosympathetic pathway, 277–278

lesions, and ptosis, 488, 492, 492fOKN. See Optokinetic nystagmusOne-and-a-half syndrome, 416–417,

416fOphthalmic artery

anatomy, 135, 136faneurysm

clinical manifestations, 543tand compressive optic neuropathy,

207branches, 135, 136, 136f, 137fon catheter angiogram, 103f, 105f

Doppler ultrasound of, 98emboli in, 138, 140low flow in, 153occlusion, 136, 148, 148f

Ophthalmic disorders, and abnormal visual perceptions, 261–262

Ophthalmoscopedirect, 22f, 28, 28f, 110, 112f

panoptic, 22f, 28, 29findirect, 22f, 110

Ophthalmoscopydirect, 30findings in, 28–32visible abnormalities seen, 36,

36f–40fOpiates, hallucinations/illusions caused

by, 268Opsoclonus, 479–480Optical coherence tomography, 84, 84f,

85f, 117of cystoid macular edema, 121, 121fof macular hole, 120, 120fof retinal nerve fiber layer, 84, 85f

Optic aphasia, 257tOptic ataxia, 256, 258tOptic atrophy, 59f, 65, 172, 172f. See

also Autosomal dominant progressive optic atrophy and deafness; Autosomal dominant progressive optic atrophy with progressive hearing loss and ataxia; DIDMOAD; Dominant optic atrophy; Hereditary optic atrophy with progressive hearing loss and polyneuropathy; Optic nerve, pallor; PEHO syndrome; Sex-linked recessive optic atrophy, ataxia, deafness, tetraplegia, and areflexia

bowtie pattern, 65, 65fsecondary to papilledema, 251f

Optic canal, 178, 178fOptic disk, 41. See also Disk-at-risk,

in anterior ischemic optic neuropathy

anomalies, 239coloboma, 232, 232fcongenital anomalies, 230–235edema. See Disk edemaelevation, without true swelling, 239infiltration, 239morning glory anomaly, 233, 233ftilted disk anomaly, 235, 235ftrue swelling, 239–240

Optic nerveanatomy, 173f–174fanomalous, 180, 228–236

604 Index

Optic nerve (cont.)blood supply to, 136, 136f, 137f, 194,

194fdisorders

and abnormal visual perceptions, 262

and transient monocular visual loss, 110

edema, 37f, 163, 163f. See also Disk edema

with central retinal vein occlusion, 156, 159f

mechanisms of, 237pearls, 163

hypoplasia, 230, 231fintracranial, 178, 179fischemia, in giant cell arteritis, 151, 551flesions

clinical characteristics, 117, 118ttopographic diagnosis, 56, 57f–59f

neoplasms affecting, 213t–214tpallor, 57f, 65, 65f. See also Optic

atrophyin optic neuropathy, 172, 172f

swelling, 237, 237f. See also Disk edema

visualization, 20, 21f, 30, 30f, 31fOptic nerve sheath fenestration, 254–

255, 255fOptic neuritis, 57f, 180, 183–193

acute idiopathic, treatment, 187acute isolated, prognosis for, 187and AION, differentiation, 196, 197tanterior, 183, 237

and disk edema, 241fassociated with other inflammatory

disorders, 184causes, 183characteristics, 183in children, 192classification, 184clinical characteristics, 181tin demyelinating disease, 184in HIV-infected (AIDS) patients, 184,

189–191, 191fidiopathic demyelinating, 180,

184–187characteristics, 184multiple sclerosis and, 184–187natural history, 185patient evaluation for, 185, 186fpearls, 184, 185, 187prognosis for, 187treatment, 187

in infectious disease, 184isolated recurrent (autoimmune), 184multiple sclerosis and, 184–187, 186f,

554, 555, 555f–556f

patient evaluation for, 183postvaccination, 184retrobulbar, 183sarcoid, 184, 191, 192fsyphilitic, 184, 189, 190f, 192

Optic neuropathy(ies), 172–236and abnormal visual perceptions, 262anterior, 172, 172f. See also Anterior

ischemic optic neuropathyassociated signs and symptoms, 175compressive/infiltrative, 180, 206–

216, 239–240causes, 207, 213t–214tclinical characteristics, 181t, 206,

208f–212f, 215f–216fdiagnosis, 207, 208f–211f, 209imaging in, 207pearls, 207

diagnosis, 56, 57f–59f, 174–179differentiation from maculopathy,

180, 182twith disk edema, and papilledema,

comparison, 244, 244tglaucomatous, 58f, 180, 226–227, 227fhereditary, 59f, 180, 217–221

classification, 217–218clinical characteristics, 181tin hereditary degenerative or

developmental diseases, 217–218

monosymptomatic, 217with other neurologic or systemic

signs, 217inflammatory, 180, 183–193, 239. See

also Optic neuritisof intracranial optic nerve, 178, 179fischemic. See Ischemic optic

neuropathyisolated, 175, 176flesion causing, localization, 175–178and light-near dissociation, 276, 276fmagnetic resonance imaging of, 96patient evaluation for, 180–182posterior (retrobulbar), 172, 172fpostoperative, 571radiation-related, 204retinal disorders mimicking, 117–122toxic/nutritional, 180, 221–223

causes, 221clinical characteristics, 181tclinical features, 221diagnosis, 221pearls, 221types, 221–223

traumatic, 180, 224–226direct, 225, 225fand disk edema, 240indirect, 225, 226f

Index 605

mechanism of injury in, 225, 225f, 226f

pearls, 226treatment, 225–226

types, 180vascular, 180, 239

Opticocochleodentate degeneration, 217

Optic pit, 234, 234fOptic radiations, 41

lesions, 68, 68f, 69fOptic tract, 41

crossed fibers of, 41lesions, 65, 65f, 66f

pearls, 67Optokinetic nystagmus, 18, 68

testing for, 18, 18f, 19t, 107Orbit(s)

anatomy, 178, 178f, 443, 443fblood supply to, 135, 135fbony deformations, 350–352deformations, evaluation, 9, 10fexamination, 9, 10f, 11f, 26tidiopathic inflammation. See Orbital

pseudotumorimaging, 88–97neurovascular structures, 178, 178fposterior view, 178fvascular disorders, 449–462vascular drainage, 449–450, 449f,

450fOrbital apex, anatomy, 398, 398fOrbital apex syndrome, 177f, 178, 397,

398–399, 399fin diabetic patient, 178pearls, 400

Orbital cellulitis, infectious, 343, 344fOrbital fractures, 348, 349fOrbital inflammatory pseudotumor,

17fOrbital ischemia, and diplopia, 350Orbital mass, and transient monocular

visual loss, 133, 133fOrbital pseudotumor, 339, 344–346,

345fclinical presentation, 346and compressive optic neuropathy,

207diagnosis, 345pearls, 347and thyroid eye disease, comparison,

342, 342t, 343ftreatment, 346

Orbital syndrome, 443–448acute, causes, 443–444clinical features, 444–445evaluation of patient with, 447–448subacute, causes, 443–444

Orbital tumor(s), 346–347Orbital varix, 462, 462fOrganic solvents, optic neuropathy

caused by, 221Oscillopsia, 268

in acquired pendular nystagmus, 474in seesaw nystagmus, 475

OTR. See Ocular tilt reaction

PPaget disease, and compressive optic

neuropathy, 207Palinopsia, 265–266, 266fPalpebral fissure, measurement, 8, 8f,

26t, 486, 486fPancoast syndrome, 289fPancreatic disorders, and Purtscher

retinopathy, 169, 169fPanretinal laser photocoagulation, for

diabetic retinopathy, 161, 161fPapilledema, 180, 237, 239, 240f, 244,

244f, 436, 437fclassification, 249–252, 250f, 251fclinical characteristics, 181tearly, 250femergent management, 246, 533imaging with, 248mechanisms, 245meningitis and, 563moderate, 250fand optic neuropathy with disk

edema, comparison, 244, 244t

pearls, 252, 533progression, 249–252, 250f, 251f,

253fsevere, 250f, 251f, 252visual loss with, 249, 252, 533

Papillitis, 183, 237Paraneoplastic retinopathy, 122, 124,

124fParaneoplastic syndromes,

neuro-ophthalmic involvement in, 569

Parasitic infectioncerebral angiitis associated with,

546optic neuritis associated with, 184

Paredrine. See Hydroxyamphetamine test

Paresis, of ocular muscle, 317Parietal lobe

focal lesions, palinopsia caused by, 265

lesions, 68, 69fParinaud syndrome. See Dorsal

midbrain syndrome

606 Index

Parkinson diseasedecreased blinking in, 500drug treatment for, hallucinations

caused by, 263, 268idiopathic, neurologic and ocular

involvement in, 582–583Paroxysmal hemicrania, episodic or

chronic, 517tPars planitis, in multiple sclerosis, 556,

557fPatch/patching

in children, 441for diplopia, 441, 441f

PCP. See Phencyclidine hydrochloridePeduncular hallucinosis, 264–265, 265fPEHO syndrome, 217Pendular nystagmus

acquired, 474clinical characteristics, 463, 463tinfantile monocular, 468localizing, 470, 470twaveform of, 464, 464f

Periarteritis nodosa, and arteritic ischemic optic neuropathy, 205

Perimetryautomated static, 49–50, 50fGoldmann (kinetic), 47, 48f, 49fHumphrey, 50, 51f, 52, 52f

Periorbital edema, 17fPeripapillary nerve fiber thickness

factors affecting, 84measurement, by optical coherence

tomography, 84, 85fPeripheral neuropathy

and multiple cranial nerve involvement, 397

and optic neuropathy, 181tPERRLA (mnemonic), 269Persistent pupillary membrane,

anisocoria caused by, 283Phacomatoses, neurologic and ocular

involvement in, 572–587Phencyclidine hydrochloride

hallucinations/illusions caused by, 268

maternal use of, and optic nerve hypoplasia, 230

Phenytoin, maternal use of, and optic nerve hypoplasia, 230

Phoria(s)definition, 315right and left designations of, 315

Phosphenes, 262migraine and, 264

Photostress recovery test, 5Pick disease, hallucinations/illusions

in, 263

Pilocarpinein diagnosis of tonic pupil, 297f, 298,

299fresponse to, in factitious mydriasis,

508, 509fPilocytic astrocytoma

clinical features, 213tand infiltrative optic neuropathy, 209,

210fPinhole testing, 2, 2fPION. See Posterior ischemic optic

neuropathyPituitary adenoma(s), 60fPituitary apoplexy, 60f, 300, 301, 301f,

405, 405fand third nerve palsy, 438

Pituitary ectopia, 230Pituitary mass, and multiple cranial

nerve involvement, 397Pituitary tumor(s), 60f, 61f, 300, 301f,

405clinical features, 213tand compressive optic neuropathy,

207, 209, 211fand seesaw nystagmus, 475, 475f

Platelet-fibrin emboli, 139fcharacteristics, 150t

Polyarteritis nodosa, optic neuritis associated with, 184

Polycoria, anisocoria caused by, 283Polyneuropathy(ies), hereditary,

associated with optic neuropathy, 217

Polyopia, 266PORN. See Progressive outer retinal

necrosisPorphyria, and binocular visual loss,

126Posterior cerebral artery(ies), 69, 70f,

131, 131faneurysm, clinical manifestations,

544ton catheter angiogram, 104finfarction, 69, 70magnetic resonance angiography of,

101fstenosis/occlusion, 131

Posterior ciliary artery(ies), 194, 194f. See also Long posterior ciliary artery(ies); Short posterior ciliary artery(ies)

Posterior communicating artery, aneurysm, 99f, 102f, 300f, 539, 540f

clinical manifestations, 543tendovascular treatment, 105, 106f

Posterior cortical atrophy, 260and binocular visual loss, 126

Index 607

Posterior inferior cerebellar artery (PICA), aneurysm, clinical manifestations, 544t

Posterior ischemic optic neuropathy, 180, 195, 548, 551

arteritic, 204–206nonarteritic, 202–204

causes, 204characteristics, 202, 203fdiagnosis, 204risk factors for, 204

Posterior leukoencephalopathy, reversible, 126

Posterior pole tumor(s), B-scan echography of, 86

Posterior scleritis, B-scan echography in, 86

Pretectal syndrome. See Dorsal midbrain syndrome

Prism(s)for quantification of ocular deviation,

325, 325fin treatment of diplopia, 442

Prism-alternate cover test, 325–326, 325f

Prism shift test, in patient with nonorganic complaint, 504

Progressive encephalopathy with edema, hypsarrhythmia, and optic atrophy. See PEHO syndrome

Progressive multifocal leukoencephalopathy (PML), 256

and binocular visual loss, 126Progressive outer retinal necrosis, 566fProprioception, testing, in nonorganic

visual loss, 504, 504fProptosis, 436, 436f

causes, 445, 446fdefinition, 9in disease, 9, 11fmeasurement, 9, 10fwith orbital varix, 462, 462fpearls, 445in thyroid eye disease, 11f

Prosopagnosia, 256, 257tPseudoedema, and true disk edema,

differentiation, 238, 238f, 238t, 239f

Pseudoptosis, 493, 494fPseudotumor cerebri. See Idiopathic

intracranial hypertensionPseudoxanthoma elasticum, 529tPsilocin, hallucinations/illusions caused

by, 268Psilocybin, hallucinations/illusions

caused by, 268

Psychiatric disordersand abnormal visual perceptions, 261and nonorganic symptoms and signs,

501Ptosis, 487–493, 509, 510f

acquired, 488–493causes, 488

after ocular surgery, 433aponeurotic, 488, 489, 489fcerebral, 493congenital, 487, 487fdefinition, 482mechanical, 488, 489, 489f, 490fin myasthenia gravis, 488, 491, 491fmyogenic, 488, 490, 490f, 491fneurogenic, 488, 492–493, 492fin neuromuscular transmission

disorders, 488, 491, 491fnonorganic, 509, 510fin ocular myasthenia, 358f, 359, 359fpearls, 490, 491postoperative, 571senile, 488, 489, 489fwith third nerve palsy, 434, 434funilateral, and contralateral lid

retraction, 494, 497, 497fPulfrich phenomenon, 262Pupil(s), 269–305

abnormalities, in comatose patient, 278, 278f

Argyll Robertson, 303clinical anatomy and physiology,

271–278, 272fconsensual response, 270direct response, 270ectopic, 282f, 283examination, 11–14, 11f, 12t, 26t,

269–270, 270f, 270tin comatose patient, 24, 25fin patient with diplopia, 436–438pearls, 14, 270PERRLA mnemonic for, 269

innervation, 271oscillation, 271postsurgical, 282freaction, in optic neuropathy, 175fsize, 269

factors affecting, 271springing, 304symmetry, 269tadpole, 302, 303ftesting, 11–14, 11f, 12t, 26t

in comatose patient, 24, 25fpearls, 14

tonic (Adie). See Adie pupilPupillary constriction. See also Miosis

with accommodation, 275–276, 275f, 276f

608 Index

Pupillary constriction (cont.)paradoxical, 303parasympathetic (cholinergic)

stimulation and, 271t, 272–273, 273f

sympathetic (adrenergic) stimulation and, 271t

Pupillary dilation, 20, 21f, 30, 30f, 277–278, 277f. See also Mydriasis

glaucoma and, 32parasympathetic (cholinergic)

stimulation and, 271tpearls, 32pharmacologic, 508, 509fsympathetic (adrenergic) stimulation

and, 271tPupillary light reflex pathway, 272–273,

273fPupillary reactions, paradoxical, 303Pursuit, testing, 318Pursuit system, control of, 431Purtscher retinopathy, 169, 169f

QQuinine, maternal use of, and optic

nerve hypoplasia, 230

RRacemose angioma. See Wyburn-Mason

syndromeRadiation optic neuropathy, 204Radiation retinopathy, 168, 168fRAPD. See Relative afferent pupillary

defectRaymond syndrome, lesion location in,

440tRed glass test, 327–330, 327f–330f

and prism quantification, 326Red reflex, 113, 113f

abnormal, 33–35, 34f, 35f, 113, 113f, 114f

asymmetric, 114normal, 33, 34f, 113, 113f, 114symmetry, examination, 19, 19f

Relative afferent pupillary defect, 12–13, 12f–14f, 41, 273–275, 274f

pathophysiology, 12pearls, 274, 275testing for, 13, 14f

Rendu-Osler-Weber syndrome, 528tRestriction, of ocular muscle, 317Retina

degeneration/dystrophy, 122detachment

B-scan echography of, 87fin diabetic retinopathy, 161

inferior, 39fand red reflex, 35, 35f

disorders, mimicking optic neuropathy, 117–122

edema, with cherry red spot, 145, 146f

inner, 117, 117fblood supply to, 136, 137f

ischemia, 138, 140acute

causes, 152, 152tevaluation of patients with, 152,

152ttreatment, 152–153

in giant cell arteritis, 151, 151flesions, topographic diagnosis, 54,

55f, 56fouter, 117, 117fstructure, 117, 117ftears, 115fvascular disorders, 145–171

Retinal infarctions, in Purtscher retinopathy, 169, 169f

Retinal nerve fibers, intraocular myelination, 236, 236f, 239, 240f

Retinal pigment epithelium (RPE), changes, in age-related macular degeneration, 119, 119f

Retinal vascular sheathing, in multiple sclerosis, 556, 556f

Retinal vascular tortuosity, 170, 170fRetinal vein ischemia, acute

causes, 157ttests for, 157t

Retinal vein occlusion, 155–159clinical features, 155natural history, 158patient evaluation for, 158prognosis for, 159treatment, 159types, 156–157

Retinitis, infectious, 114fRetinitis pigmentosa, 54, 56fRetinoblastoma, 113fRetinopathy

and abnormal visual perceptions, 261–262, 262f

acute zonal occult outer, 121, 262cancer-associated, 124, 262central serous, 117, 118f

fluorescein angiography, 82fcongenital, 303degenerative/dystrophic, 122diabetic, 160–161, 160f–161f

nonproliferative, 36f, 160fproliferative, 160–161, 160f

Index 609

hypertensive, 37f, 162–164, 162f–164facute, 164, 164f

clinical features, 164clinical features, 163–164

hypotensive, 153–155, 153fmelanoma-associated, 124paraneoplastic, 122, 124, 124fPurtscher, 169, 169fradiation, 168, 168ftoxic, 122venous stasis, 141, 141f, 153–155,

153f, 154fvitamin A deficiency, 122

Riddoch phenomenon, 267Riley-Day syndrome. See Familial

dysautonomiaRoth spots, 150t

SSaccades. See also Square-wave jerks

abnormal, 463back-up (catch-up), 481horizontal, pathway for, 430–431slow, differential diagnosis, 431testing, 318, 319fvertical, pathway for, 431

Saccade system, control of, 430–431Saccadic hypermetria, 481Saccadic hypometria, 481Saccadic intrusions (oscillations),

479–481evaluation of patient with, 481f

SANDO syndrome, and chronic progressive external ophthalmoplegia, 355

Sarcoidosis, 559–562clinical manifestations, 559clinical presentation, 559diagnosis, 562and infiltrative optic neuropathy, 207,

240neurologic manifestations, 559, 560fneuro-ophthalmic manifestations,

561, 561foptic neuritis associated with, 184,

191, 192fand retinal vasculitis, 167treatment, 562

Scotoma(s)central, 55f, 56centrocecal, 56, 57f, 59fjunctional, 41, 61f

in optic neuropathy, 178, 179fmigraine and, 264, 264f, 516paracentral, 56, 82f

Scotomatous defect(s), homonymous, 70, 71f, 75f

Sectoranopia, 67fSeesaw nystagmus, 470t, 475, 475fSeizure(s)

occipital. See Occipital seizurespalinopsia caused by, 265

Sensory ataxic neuropathy, dysarthria, and ophthalmoplegia. See SANDO syndrome

Septo-optic dysplasia, 230, 231fSeventh nerve palsy(ies), 366, 368fSex-linked recessive optic atrophy,

ataxia, deafness, tetraplegia, and areflexia, 217

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing. See SUNCT syndrome

Short posterior ciliary artery(ies), 136, 136f, 137f, 194, 194f

Shunt vessel(s)with central retinal vein occlusion,

159, 159fwith optic nerve sheath meningioma,

243fSiderosis, ocular, 283fSilent sinus syndrome, 352, 352fSimultagnosia, 256, 258tSinusitis, infectious, 343, 344fSixth nerve palsy(ies), 365–375, 365f,

434, 434f, 436–437, 437facquired, causes, 366–372, 367t, 368f,

369fin children, 373congenital, 372–373with contralateral hemiparesis, lesion

location in, 440tevaluation of patient for, 374–375with ipsilateral Horner syndrome,

lesion location in, 440twith ipsilateral seventh nerve palsy

and contralateral hemiparesis, lesion location in, 440t

microvascular, 369–371, 370fpearls, 370

mimickers of, 373–374postganglionic (third order) Horner

syndrome and, 291, 291fSjögren syndrome, optic neuritis

associated with, 184Skew deviation, 429, 429fSlit-lamp examination, 15, 15f, 16f, 110,

269, 281Smallpox, tetanus, diphtheria vaccine,

optic neuritis associated with, 184

Small vessel disease, classification, 525Spasm of convergence, 305, 305f, 374,

374f, 417, 418f, 508, 508f

610 Index

Spasm of the near triad, 305, 305f, 374, 374f, 417, 418f, 508, 508f

Spasmus nutans, 468Sphenoid wing

agenesis, 351, 351f, 573, 574fdysplasia, 573, 574f

Spinocerebellar ataxia(s), 217Spinocerebellar degeneration, 473fSpringing pupil, 304Squamous cell carcinoma, 406, 407f–

408fSquare-wave jerks, 480, 480fStereopsis, correlation with visual

acuity, 7, 7t, 503, 503tStereovision, 107

testing, 7, 7fin patient with nonorganic

complaint, 503, 503fStorage diseases, and optic neuropathy,

217Strabismus, 125

comitant (concomitant), 314–315definition, 18, 314detection, 18incomitant (noncomitant), 314–315surgery for, 442

Stroke. See also Cerebral infarctionclinical presentation, 519computed tomography of, 89, 90fdefinition, 519hemorrhagic, 519–520, 520fischemic, 519–520, 520f

risk factors for, 525–526magnetic resonance imaging of, 96suspected, laboratory and diagnostic

tests recommended for, 526Sturge-Weber syndrome, neurologic

and ocular involvement in, 529t, 577–578, 577f

Subarachnoid hemorrhage, 535f, 536, 539–544, 540f

on catheter angiogram, 105, 106fcauses, 541clinical presentation, 539and diplopia, 348prognosis for, 539

Subdural hemorrhage, 534, 535fSUNCT syndrome, 517tSuperior cerebellar artery, aneurysm,

clinical manifestations, 544tSuperior oblique myokymia, 478, 479fSuperior oblique paresis, 375, 375f, 376Superior ophthalmic vein thrombosis,

461, 461fSuperior orbital fissure, 178, 178fSupranuclear ocular motor disorders,

410–432Supranuclear palsy, 582

Surgerynonocular noncranial, visual loss

during, 571ocular, visual loss during, 571

Susac syndrome, 150, 165Synechiae, posterior, 281fSyphilis

Argyll Robertson pupils in, 303neurologic and ocular involvement in,

563, 564, 564foptic neuritis associated with, 184,

189, 190f, 192and retinal vasculitis, 167

Systemic lupus erythematosus (SLE)and arteritic ischemic optic

neuropathy, 205optic neuritis associated with, 184and retinal vasculitis, 167

TTacrolimus, CNS toxicity, and binocular

visual loss, 126Tadpole pupil, 302, 303fTalc emboli, characteristics, 150tTangent screen, 46–47, 47f

in nonorganic visual field constriction, 507, 507f

TCD. See Transcranial DopplerTemporal arteritis. See Giant cell

arteritisTemporal artery biopsy, 552, 553fTemporal lobe tumor(s), 64fTensilon test. See Edrophonium

(Tensilon) testTeratogen(s), and optic nerve

hypoplasia, 230Terson syndrome, 25, 35f, 541–542, 541fTetanus toxoid, optic neuritis associated

with, 184Thalamic esotropia, 373, 374fThalamic hemorrhage, 426, 426fThiamine deficiency, 410

pearls, 476Third nerve palsy(ies), 376, 377f,

382–397, 385f–388f, 434, 434f, 438, 439f, 509

acquired, causes, 391, 391tcase examples, 392–394, 392f, 393f,

394fin children, 395classification, 388clinical presentation, 382, 383fcomplete, 388

with pupil involvement, 388–389, 389f

pupil-sparing, 388, 389congenital, 395, 487

Index 611

with contralateral ataxia with tremor, lesion location in, 440t

with contralateral hemiparesis, lesion location in, 440t

with contralateral ptosis and contralateral superior rectus weakness, lesion location in, 440t

with contralateral tremor, lesion location in, 440t

with depressed mental status, lesion location in, 440t

evaluation of patient for, 390–391, 390fintracranial aneurysm and, 300, 300f,

301, 389, 392–394, 392f, 393f, 394f

with ipsilateral cerebellar ataxia, lesion location in, 440t

microvascular, 389and mydriasis, 299–301, 299f, 300fpartial, 388pearls, 395, 396, 438prognosis for, 397and ptosis, 493, 493fwith pupil involvement, 438, 439fwith subarachnoid hemorrhage, 539

Three-step test, 324, 324fThrombocytopenia, 38fThrombophilia

congenital, 527evaluation of patients with, 152tscreening for, 527

Thrombosis. See also Cerebral venous thrombosis

risk factors for, 527Thymoma, malignant, paraneoplastic

retinopathy with, 124fThyroid eye disease (ophthalmopathy),

240, 339–342associated with myasthenia, 363, 364fB-scan echography in, 86clinical presentation, 339–342, 340f,

341fand compressive optic neuropathy,

207, 212fdiagnosis, 342eyelid retraction in, 494, 495, 495f,

496fmuscles involved in, 341and orbital pseudotumor, comparison,

342, 342t, 343fpearls, 341, 445proptosis in, 11f, 339, 340f, 342, 445,

446ftreatment, 342

TIA. See Transient ischemic attacksTilted disk anomaly, 235, 235fTitmus test, 7, 7f

TMVL. See Transient monocular visual loss

Tobacco, optic neuropathy caused by, 221

Tobias syndrome. See Pancoast syndrome

Tolosa-Hunt syndrome, 403, 403fTopographagnosia, 256, 258tTorticollis, 435Toxemia of pregnancy. See also

Eclampsiaand binocular visual loss, 132

Toxic retinopathy, 122Toxin(s)

causing optic neuropathy, 221and disk edema, 237, 240hallucinations/illusions caused by,

268Toxocariasis, optic neuritis associated

with, 184Toxoplasmosis

optic neuritis associated with, 184, 189

and retinal vasculitis, 167retinitis caused by, 114f

Transcranial Doppler, 98Transesophageal echocardiography,

149fTransient ischemic attacks, occipital,

132tand binocular visual loss, 129–131

Transient monocular visual loss, 128, 133–144

associated symptoms, 134causes, 110, 128differential diagnosis, 133–134duration, 134gaze-evoked, 110, 133, 133fonset, 134patient evaluation for, 134in patients older than age 50, 142pearls, 133vascular, 110, 135–143

mechanisms of, 138–142, 139f–142fnatural history, 142patient evaluation for, 142–143,

143fpearls, 142risks associated with, 142treatment, 144

Transient visual obscurations, 133Trauma. See also Optic neuropathy(ies),

traumaticanisocoria caused by, 283, 294and binocular visual loss, 126, 132B-scan echography in, 86, 87fand cervical artery dissections, 522computed tomography in, 89

612 Index

Trauma (cont.)facial, anisocoria after, 283fhead, diplopia after, 348iris tears caused by, 282f, 283forbital, 348, 349f

diplopia after, 348pearls, 226and periodic alternating nystagmus,

472and Purtscher retinopathy, 169

Traumatic brain injury, neuro-ophthalmic involvement in, 569–570

Traumatic hyphema, 112fTrichinosis, 343Trigeminal neuralgia

classic, 517tsymptomatic, 517t

Trigeminal zoster, 406, 406fTrigemino-oculomotor synkinesis, 487Trochlear nerve. See Cranial nerve(s), IV;

Fourth nerve palsy(ies)Trophyrema whippelii, 567Tropia(s)

definition, 315right and left designations of, 315

T sign, 86Tuberculosis, optic neuritis associated

with, 184Tuberous sclerosis, 528t

diagnosis, 575–576neurologic and ocular involvement in,

575–576, 575f, 576fTumor(s)

extraocular muscle involvement in, 346–347, 348f

imaging, 207and infiltrative optic neuropathy,

207intracranial, neurologic and ocular

involvement in, 568–569intraocular, anisocoria caused by,

283intraorbital, and compressive optic

neuropathy, 207proptosis caused by, 445, 446f

TVOs. See Transient visual obscurations

UUhthoff phenomenon, 110, 184Ultrasound. See also Echography, ocular/

orbitalin orbital syndrome, 448transcranial Doppler, 98vascular, 97–98, 97f, 98f

Upbeat nystagmus, 470t, 471, 471f

Upgaze limitation, in elderly, 428Upgaze paresis, 422–426, 422f, 423f

VVariola, vaccine, optic neuritis

associated with, 184Varix, orbital, 462, 462fVascular disorders

and binocular visual loss, 126, 127fdrug-related, mimicking cerebral

angiitis, 547noninflammatory, mimicking cerebral

angiitis, 547orbital, 449–462retinal, 145–171, 519, 520and transient monocular visual loss,

110, 135–143mechanisms of, 138–142,

139f–142fnatural history, 142patient evaluation for, 142–143, 143fpearls, 142risks associated with, 142treatment, 144

Vascular malformationsintracranial, 538fretinal, 171, 171f, 538, 538f

Vasculitiscerebral, 545–547fluorescein angiography, 82, 83, 83foptic neuritis associated with, 184retinal, 165–167, 165f–167f

causes, 166systemic disorders associated with,

167and sixth nerve palsy, 370, 371fsystemic, and arteritic ischemic optic

neuropathy, 205Venography. See CT venography;

Magnetic resonance venography (MRV)

Venous angioma, orbital, 462, 462fVenous hypertension, causes, 246Venous return, decreased, causes, 246Venous sinuses, intracranial, 531f, 532Venous stasis retinopathy, 141, 141f,

153–155, 153f, 154fVenous system, intracranial, 530–532,

530f, 531fVergence

definition, 17evaluation, 319, 320f

Version(s), definition, 17Vertebral artery(ies)

aneurysm, clinical manifestations, 544t

Index 613

on catheter angiogram, 104fdissection, 522magnetic resonance angiography of,

101f, 102fultrasound of, 97–98

Vertebrobasilar ischemia, and binocular visual loss, 126

Vertebrobasilar system, 130, 130fVertical gaze palsy, causes, 428Vertigo, positional, nystagmus with,

469, 469fVestibulo-ocular reflex, in comatose

patient, 25Vestibulo-ocular system, 431–432Viral infection

cerebral angiitis associated with, 546

optic neuritis associated with, 184Visual acuity

correlation with stereopsis, 7, 7t, 503, 503t

decreased, with bilateral retrochiasmal visual pathway lesions, 74, 75f

distance, testing, 2, 2f, 26timproved by looking through pinhole,

107near, testing, 3, 3f, 26ttesting, 2–3, 2f, 26t

in patient with diplopia, 436in patient with nonorganic

complaint, 502Visual allesthesia, 266Visual evoked responses (visual evoked

potentials), 76–77, 77f, 78fin nonorganic visual loss, 506in optic neuropathy, 175, 176f

Visual field(s)constriction, nonorganic, 506–507,

506f, 507fnormal, 41, 43fquality, assessment, 52, 52fand retina, relationships of, 41vascular malformations and, 539, 539f

Visual field defectsinterpretation, 50–53secondary to lesions affecting visual

pathways, 41, 42f–43ftopographic diagnosis, 54–75

Visual field testing, 19, 27t, 41–75at bedside, 44–45, 45f, 46finterpretation, 53, 54fin office, 46–50, 47f–50fpearls, 53, 75techniques for, 44–50

Visual lossapproach to patient with, 107

binocular, 107, 125–127permanent, causes, 126transient, 128–132

causes, 126, 128differential diagnosis, 128–132

giant cell arteritis and, 549meningitis and, 563monocular, 107, 109–125

anatomical localization, 116fcauses, 109with central retinal artery

occlusion, 146with ophthalmic artery occlusion,

148partial, with branch retinal artery

occlusion, 148permanent, causes, 110–113with retinal vein occlusion, 155–159

new-onset, in neurologic patient, 519nonorganic, 107, 501–502

examination of patient with, 502in one eye only, 502–504, 503f

with papilledema, 249, 252, 533pearls, 107posttraumatic, 569–570during surgery, 571transient, 128–144. See also Transient

monocular visual lossevaluation, 128

pearls, 128Visual object agnosia, 257tVisual pathways, 41, 107, 108f

anterior, lesions, topographic diagnosis, 54–60

imaging, 88–97intracranial

anatomy, 125flesions, 125–126

lesions affecting, 41, 42f–43fretrochiasmal, lesions, topographic

diagnosis, 61–74Visual perceptions, abnormal. See

Abnormal visual perception(s)Vitamin A deficiency retinopathy, 122Vitamin B12 deficiency, optic

neuropathy caused by, 221, 223, 224f

Vitritis, 114fvon Hippel-Lindau disease, neurologic

and ocular involvement in, 528t, 576, 576f

VOR. See Vestibulo-ocular reflex

WWallenberg syndrome, 289, 289f

lesion location in, 440t

614 Index

Wall-eyed bilateral internuclear ophthalmoplegia, 414

Watershed infarction, 256Weber syndrome, lesion location in, 440tWegener granulomatosis, optic neuritis

associated with, 184Wernicke encephalopathy, 397, 410

nystagmus in, 476pearls, 476

Whipple diseaseclinical presentation, 567diagnosis, 567neurologic and ocular involvement

in, 567oculomasticatory myorhythmia in, 476optic neuritis associated with, 184treatment, 567

White reflex. See LeukocoriaWilbrand’s knee, 41Wilson disease, neurologic and ocular

involvement in, 583–584, 584f

Wolfram syndrome. See DIDMOADWyburn-Mason syndrome, neurologic

and ocular involvement in, 529t, 538f, 578

XXanthopsia, 268

ZZoster. See Herpes zoster