Editor’s Preface * 2014, American Academy of Neurology.
You, Yourself, and Eye Neurologic diseases commonly neurologic complication present with abnormalities of of systemic disorders. vision or eye movement; all Drs Biousse and Newman neurologists should therefore again share their expertise be well versed in the neuroanatwith us as they review the omy, pathophysiology, diagnodiagnosis and managesis, and management of the ment of the retinal and many neurologic disorders that optic nerve ischemic syninclude symptoms and signs of dromes that can present neuro-ophthalmic dysfunction. to neurologists, including At the same time, neurologists a discussion of both the should also have some knowlsimilarities and differedge of those purely ophthalmic ences between retinal disorders that can resemble and cerebral ischemia. primary neurologic or neuroIn the next article, ophthalmic disorders, especially Dr Deborah I. Friedman My sincerest thanks so as to refer these patients discusses the critically appropriately and expeditiously. to Guest Editor important neurologic Finally, neurologists should examination finding of Janet C. Rucker, MD, have an understanding of papilledema, as well as for her tireless efforts, the role of specialized neurothe clinical syndrome of ophthalmologic diagnostic pro- as well as for the work of idiopathic intracranial each of the members cedures, even those procedures hypertension, a disorder that are not within the typical for which the results of of her wonderful neurologist’s armamentarium. In the very recently reported team of experts, for , this issue of Idiopathic Intracranial putting together this Guest Editor Janet C. Rucker, Hypertens i o n T r i a l , tremendously MD, from NYU Langone Medical described in her article, Center, New York University, now provide the first thorough, up-to-date, along with her assembled evidence-based treatand highly readable group of world-class neuroment recommendations. compendium of ophthalmologist authors and Dr Gregory P. Van neuro-ophthalmology. Stavern provides a clear educators, has created a remarkable volume to assist in and encyclopedic review the evaluation, diagnosis, and management of the diagnosis and management of the many disorders of vision and eye of the many optic neuropathies that are movement that can present to us as due to metabolic and hereditary etiologies neurologists. (emphasizing that many of these share a The issue begins with a set of articles common pathophysiologic pathway of devoted to the diagnosis, pathophysiology, mitochondrial dysfunction), as well as those and management of visual loss. I’m thrilled optic neuropathies with traumatic, neoplastic, that Drs Nancy Newman and Val2rie Biousse and paraneoplastic causes. Dr Christopher C. have kicked off this section and this issue by Glisson next discusses the visual loss caused sharing their expertise with us as they by the various kinds of lesions that can provide their diagnostic approach to vision occur at the optic chiasm and within the loss in a remarkably thorough, clear, retrochiasmal visual pathways. The final and extensively illustrated article. Dr Fiona contribution to the set of articles devoted Costello next provides an up-to-date review to visual loss in this issue is provided by of the diagnosis and management of the Dr Jason J. S. Barton, who provides an inflammatory optic neuropathies that can be extensive and state-of-the-art review of those seen in primary neurologic disease or as a complex and fascinatingVbut unfortunately Continuum (Minneap Minn) 2014;20(4):783–784
www.ContinuumJournal.com
Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
783
Editor’s Preface
often quite disablingVvisual deficits that occur because of higher cortical (extrastriate) dysfunction of either the ventral (‘‘what’’) stream (eg, prosopagnosia) or the dorsal (‘‘where’’) stream (eg, Balint syndrome). The next set of articles is devoted to the diagnosis, pathophysiology, and management of those disorders that affect eye movements. Dr Marc Dinkin kicks off this section with his step-by-step (and wellillustrated) roadmap for the practicing neurologist on how to approach the history and neuro-ophthalmologic examination of the patient presenting with diplopia. Dr Wayne T. Cornblath next reviews the diagnostic approach to patients presenting with the commonly encountered clinical problem of diplopia caused by lesions involving the third, fourth, or sixth cranial nerves. Dr Eric R. Eggenberger provides a detailed review of the supranuclear control of eye movements and the symptoms and signs that serve as diagnostic clues to lesions occurring within these pathways. In the final article within the disorder-of-eyemovement theme, Dr Matthew J. Thurtell provides his diagnostic approach to abnormal spontaneous eye movements (eg, nystagmus and saccadic intrusions), including a clear explanation of the clinical phenomenology, as well as the neurologic examination, diagnostic evaluation, and symptomatic management of patients with these eye movement disorders. Moving on to the pupils, Dr Aki K. Kawasaki provides her thoughtful and clearly delineated approach to the evaluation and diagnosis of disorders of pupillary function. In the final review article of this issue, Dr Sashank Prasad provides a remarkably thorough reviewVillustrated with carefully chosen examples grouped at the end of the articleVof the various diagnostic neuroimaging findings that may be seen in the many neuro-ophthalmic disorders we can encounter in our daily neurologic practices. In this issue’s Ethical Perspectives section, Dr Aimee J. Szewka, along with Dr Nancy Newman, dissect the ethical issues that arise when discovering incidental visual field loss and its potential impact on a patient’s fitness for driving, including issues related to reporting. In this issue’s Practice section, Dr Michael Wall provides a practical discussion of formal visual field testing and the critical importance of serial perimetry in monitoring patients with idiopathic intracranial
784
hypertension and in assisting in communication between providers. Finally, Dr Benjamin M. Frishberg uses several illustrative case examples as springboards to review special considerations involved in coding for patients with neuroophthalmic disorders, a discussion of relevance to any neurologist seeing patients with neuro-ophthalmic disease. issue, a As with every number of opportunities exist for CME. If you need to earn credits specifically approved by the American Board of Psychiatry and Neurology (ABPN) for selfassessment, submit your answers to the multiple-choice questions in the SelfAssessment Pretest that were crafted by Drs Eduardo E. Benarroch and D. Joanne Lynne, before you read the issue; review your results to better tailor your learning needs; and then complete the Postreading CME Test after reading the issue. By doing so you may earn up to 12 AMA PRA Category 1 CME Creditsi toward selfassessment. Alternatively, you may wish to receive credits toward CME only, in which case, reading the issue and submitting the Postreading CME Test will allow you to earn up to 10 AMA PRA Category 1 CME Credits. The Patient Management Problem, expertly crafted by Dr Steven L. Galetta, involves the management of a 27-year-old man presenting with transient grayouts of vision superimposed on a history of headache. By following this case and answering multiple-choice questions corresponding to important pathophysiologic and diagnostic decision points leading to his ultimateVand very instructiveVdiagnosis, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits. My sincerest thanks to Dr Rucker for her tireless efforts, as well as for the work of each of the members of her wonderful team of experts, for putting together this tremendously thorough, up-to-date, and highly readable compendium of neuro-ophthalmology. This volume should serve as an amazing resource for all neurologists (whether on our bookshelves, our tablets, or online), covering so much material that will help us provide the most up-to-date and informed management to our many patients with disorders affecting vision or eye movement. VSteven L. Lewis, MD, FAAN Editor-in-Chief
www.ContinuumJournal.com
Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
August 2014
You, Yourself, and Eye Neurologic diseases commonly neurologic complication present with abnormalities of of systemic disorders. vision or eye movement; all Drs Biousse and Newman neurologists should therefore again share their expertise be well versed in the neuroanatwith us as they review the omy, pathophysiology, diagnodiagnosis and managesis, and management of the ment of the retinal and many neurologic disorders that optic nerve ischemic syninclude symptoms and signs of dromes that can present neuro-ophthalmic dysfunction. to neurologists, including At the same time, neurologists a discussion of both the should also have some knowlsimilarities and differedge of those purely ophthalmic ences between retinal disorders that can resemble and cerebral ischemia. primary neurologic or neuroIn the next article, ophthalmic disorders, especially Dr Deborah I. Friedman My sincerest thanks so as to refer these patients discusses the critically appropriately and expeditiously. to Guest Editor important neurologic Finally, neurologists should examination finding of Janet C. Rucker, MD, have an understanding of papilledema, as well as for her tireless efforts, the role of specialized neurothe clinical syndrome of ophthalmologic diagnostic pro- as well as for the work of idiopathic intracranial each of the members cedures, even those procedures hypertension, a disorder that are not within the typical for which the results of of her wonderful neurologist’s armamentarium. In the very recently reported team of experts, for , this issue of Idiopathic Intracranial putting together this Guest Editor Janet C. Rucker, Hypertens i o n T r i a l , tremendously MD, from NYU Langone Medical described in her article, Center, New York University, now provide the first thorough, up-to-date, along with her assembled evidence-based treatand highly readable group of world-class neuroment recommendations. compendium of ophthalmologist authors and Dr Gregory P. Van neuro-ophthalmology. Stavern provides a clear educators, has created a remarkable volume to assist in and encyclopedic review the evaluation, diagnosis, and management of the diagnosis and management of the many disorders of vision and eye of the many optic neuropathies that are movement that can present to us as due to metabolic and hereditary etiologies neurologists. (emphasizing that many of these share a The issue begins with a set of articles common pathophysiologic pathway of devoted to the diagnosis, pathophysiology, mitochondrial dysfunction), as well as those and management of visual loss. I’m thrilled optic neuropathies with traumatic, neoplastic, that Drs Nancy Newman and Val2rie Biousse and paraneoplastic causes. Dr Christopher C. have kicked off this section and this issue by Glisson next discusses the visual loss caused sharing their expertise with us as they by the various kinds of lesions that can provide their diagnostic approach to vision occur at the optic chiasm and within the loss in a remarkably thorough, clear, retrochiasmal visual pathways. The final and extensively illustrated article. Dr Fiona contribution to the set of articles devoted Costello next provides an up-to-date review to visual loss in this issue is provided by of the diagnosis and management of the Dr Jason J. S. Barton, who provides an inflammatory optic neuropathies that can be extensive and state-of-the-art review of those seen in primary neurologic disease or as a complex and fascinatingVbut unfortunately Continuum (Minneap Minn) 2014;20(4):783–784
www.ContinuumJournal.com
Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
783
Editor’s Preface
often quite disablingVvisual deficits that occur because of higher cortical (extrastriate) dysfunction of either the ventral (‘‘what’’) stream (eg, prosopagnosia) or the dorsal (‘‘where’’) stream (eg, Balint syndrome). The next set of articles is devoted to the diagnosis, pathophysiology, and management of those disorders that affect eye movements. Dr Marc Dinkin kicks off this section with his step-by-step (and wellillustrated) roadmap for the practicing neurologist on how to approach the history and neuro-ophthalmologic examination of the patient presenting with diplopia. Dr Wayne T. Cornblath next reviews the diagnostic approach to patients presenting with the commonly encountered clinical problem of diplopia caused by lesions involving the third, fourth, or sixth cranial nerves. Dr Eric R. Eggenberger provides a detailed review of the supranuclear control of eye movements and the symptoms and signs that serve as diagnostic clues to lesions occurring within these pathways. In the final article within the disorder-of-eyemovement theme, Dr Matthew J. Thurtell provides his diagnostic approach to abnormal spontaneous eye movements (eg, nystagmus and saccadic intrusions), including a clear explanation of the clinical phenomenology, as well as the neurologic examination, diagnostic evaluation, and symptomatic management of patients with these eye movement disorders. Moving on to the pupils, Dr Aki K. Kawasaki provides her thoughtful and clearly delineated approach to the evaluation and diagnosis of disorders of pupillary function. In the final review article of this issue, Dr Sashank Prasad provides a remarkably thorough reviewVillustrated with carefully chosen examples grouped at the end of the articleVof the various diagnostic neuroimaging findings that may be seen in the many neuro-ophthalmic disorders we can encounter in our daily neurologic practices. In this issue’s Ethical Perspectives section, Dr Aimee J. Szewka, along with Dr Nancy Newman, dissect the ethical issues that arise when discovering incidental visual field loss and its potential impact on a patient’s fitness for driving, including issues related to reporting. In this issue’s Practice section, Dr Michael Wall provides a practical discussion of formal visual field testing and the critical importance of serial perimetry in monitoring patients with idiopathic intracranial
784
hypertension and in assisting in communication between providers. Finally, Dr Benjamin M. Frishberg uses several illustrative case examples as springboards to review special considerations involved in coding for patients with neuroophthalmic disorders, a discussion of relevance to any neurologist seeing patients with neuro-ophthalmic disease. issue, a As with every number of opportunities exist for CME. If you need to earn credits specifically approved by the American Board of Psychiatry and Neurology (ABPN) for selfassessment, submit your answers to the multiple-choice questions in the SelfAssessment Pretest that were crafted by Drs Eduardo E. Benarroch and D. Joanne Lynne, before you read the issue; review your results to better tailor your learning needs; and then complete the Postreading CME Test after reading the issue. By doing so you may earn up to 12 AMA PRA Category 1 CME Creditsi toward selfassessment. Alternatively, you may wish to receive credits toward CME only, in which case, reading the issue and submitting the Postreading CME Test will allow you to earn up to 10 AMA PRA Category 1 CME Credits. The Patient Management Problem, expertly crafted by Dr Steven L. Galetta, involves the management of a 27-year-old man presenting with transient grayouts of vision superimposed on a history of headache. By following this case and answering multiple-choice questions corresponding to important pathophysiologic and diagnostic decision points leading to his ultimateVand very instructiveVdiagnosis, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits. My sincerest thanks to Dr Rucker for her tireless efforts, as well as for the work of each of the members of her wonderful team of experts, for putting together this tremendously thorough, up-to-date, and highly readable compendium of neuro-ophthalmology. This volume should serve as an amazing resource for all neurologists (whether on our bookshelves, our tablets, or online), covering so much material that will help us provide the most up-to-date and informed management to our many patients with disorders affecting vision or eye movement. VSteven L. Lewis, MD, FAAN Editor-in-Chief
www.ContinuumJournal.com
Copyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
August 2014
