Experts discussed the diagnosis and management for sightthreatening, neuro-ophthalmic red flags,
including diplopia, sudden visual loss and eye pain, in a symposium co-organized with the North American Neuro-ophthalmology Society (NANOS)
on Day 2 of the 36th Asia-Pacific Academy of Ophthalmology Virtual Congress (APAO 2021).
Dire diplopia Diplopia, commonly known as double vision, can be a serious cause of concern.
According to Prof. Clare Fraser from the University of Sydney, Australia, when it comes to diagnosing dire diplopia, there are five causes that should not be missed ลาวสามัคคี วีไอพี.
These are aneurysmal third palsy, non-isolated sixth nerve palsy, giant cell arteritis, pituitary apoplexy, and cancer (metastatic or perineural spread).
She noted that a clinical feature that is especially worrisome is headache, particularly if it’s associated with skull tenderness, fever and chills, and if it’s a new onset headache located at the temple region.
Other localization signs are vision loss, facial sensory changes,
pupil changes and ptosis, facial weakness, and auditory or balance issues.
“Be suspicious, make sure nerve palsy is truly isolated. In case of third nerve palsy, particularly if it’s partial and the pupil is involved, make sure you do the appropriate imaging of the aneurysm of the posterior communicating artery.
Headache and double vision can be due to space occupying the lesion/aneurysm, pituitary apoplexy and carotid cavernous fistula.
Myasthenia gravis and giant cell arteritis always needs to be on the list. Be prepared to reassess your diagnosis.
Microvascular nerve palsy can only be diagnosed in retrospect once it has recovered,” she summed up.
A case of dramatic and sudden vision loss Meanwhile, Prof. Dan Milea from the Singapore National Eye Centre (SNEC), talked about dramatic and sudden vision loss.
He shared a case involving a 28-year-old female patient with painful and rapid visual loss (20/50) in the left eye, with no past medical history.
Three months earlier, she had a similar episode where the MRI was normal and she had a rapid spontaneous recovery.
MRI was repeated for the second episode and with contrast, it revealed a dark zone at the chiasm and a possibly squeezed left optic nerve. Looking back at the first MRI, Prof.
Milea disagreed that it was normal as he observed a little bit of growth at one side of the top of the optic nerve close to the chiasm.
Results from a lumbar puncture were normal and systemic inflammatory
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