logging in or signing up Optic Neuritis & Papilledema araiqa Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Copy Does not support media & animations WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 1627 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: February 11, 2012 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Slide 2: A young patient of age 28 years presented in eye OPD with c/o of severe headache, projectile vomiting and visual obscurations – off & on Slide 3: On examination visual acuity was normal in both eyes but he had some problem in differentiating colours Pupils showed relative afferent Pupillary defect Slide 4: WHAT IS THE DIFFERENTIAL DIAGNOSIS ?? WHAT IS THE PROBABLE DIAGNOSIS -- & WHY ?? HOW WILL YOU INVESTIGATE & MANAGE THE CASE ?? Papilledema : Papilledema It is the swelling of the optic nerve head (usually bilateral) arising from raised intracranial pressure ( the term should not be used to describe other causes of disc edema ) Mechanism : Mechanism Raised intra cranial pressure is transmitted from the subarachnoid space via the optic nerve sheath to cause axoplasmic hold up and consequent disc edema Normal flow of CSF : Normal flow of CSF Clinical features - symptoms : Clinical features - symptoms Visual obscurations (transient decreased vision for a few seconds 30 x times / day; may be precipitated by posture, straining) Diplopia Headaches (often worse on straining or lying down ) Nausea, vomiting, pulsatile tinnitus Clinical features - signs : Clinical features - signs Field defects (usually enlarged blind spot) Sustained decreased vision Disc swelling usually bilateral Normal Optic Nerve Head : Normal Optic Nerve Head Signs & Symptoms : Signs & Symptoms Severely hyperemic & raised optic discs Small vessels are obscured Venous engorgement, margin hemorrhages & frequently cotton wool spots. Optic disc appears large Hard exudates may form macular star The blind Spot is enlarged FFA: early & late findings : FFA: early & late findings Longstanding Papilledema : Longstanding Papilledema optic atrophy : optic atrophy Differential Diagnosis : Differential Diagnosis Congenital Disc Anomalies Buried drusen Myelinated nerve fibers Bilateral disc swellings Malignant hypertension Bilateral Papillitis Bilateral thyroid Ophthalmopathy Bilateral AION Bilateral compromised venous drainage e.g. CRVO and Carotid-cavernous fistula Myelinated Nerve Fibres : Myelinated Nerve Fibres Optic Disc Drusen : Optic Disc Drusen AION : AION Slide 21: Papillitis: Megalopapilla : Megalopapilla Hypermetropic disc : Hypermetropic disc Dysplastic Disc : Dysplastic Disc Papilledema VS papillitis : Papilledema VS papillitis True Papilledema, even in the fully developed form, does not reduce acuity unless it causes optic atrophy nor does it present with field defects other than enlarged blind spots. Optic Neuritis : Definition : Optic Neuritis : Definition The term optic neuritis signifies acute, sub-acute inflammation or demyelination of the optic nerve Slide 27: Retrobulbar neuritis Papillitis Neuroretinitis Ophthalmoscopic Classification Slide 28: Demyelinating: The most common Multiple Sclerosis Para infectious: Follows Viral Infection or immunization Infectious: Sinus related Cat-scratch fever Syphilis Lyme disease Etiological Classification Clinical Features (symptoms)typical optic neuritis : Clinical Features (symptoms)typical optic neuritis Age 20 – 50 years / unilateral Rapid decrease in visual acuity over hours/days Recovery starts within 2 weeks few months colour vision disturbed Field loss (variable pattern) Retrobulbar pain (90%- worse on eye movements- usually precedes decrease in vision) Optic Neuritis Normal Clinical Features (signs) : Clinical Features (signs) RAPD (relative afferent pupillary defect)- may be absent if pre existing contra lateral disease Disc swelling (only 1/3 of cases) May have a few hemorrhages/ retinal exudates Mild vitritis Neuroretinitis: : Neuroretinitis: Treatment : Treatment When Visual loss is mild, no treatment When Visual loss is > 6/12 IV methylprednisolone sodium succinate1 g daily for 3 days followed by oral prednisolone 1mg/kg/daily for 11 days Devic’s DiseaseNeuromyelitis optica : Devic’s DiseaseNeuromyelitis optica Is characterized by bilateral optic neuritis with transverse myelitis. Patients present with rapid severe bilateral visual loss with paraplegia Leber’s hereditary optic neuropathy : Leber’s hereditary optic neuropathy Rare condition Maternally inherited- mitochondrial DNA Any age but typically young adult males Sudden sequential painless visual loss – 6/60 – HM Usually affects 2nd eye with in 2 months Slide 36: THANKS You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.