Tuesday, September 4, 2012

Clinical cases of ophthalmological problems associated with neurological diseases

Q1- 7 years old boy- present with head ache and repeated vomiting after FFH
CT-scan show no features of brain edema, and treated conservatively
In the second day, the patient had visual loss
Ophthamological examination show:
No features of internal and external ophthalmoplegia
Normal reacting pupil
Normal fundus
*What is the possible cause of visual loss and why?
Most propably due ho cortical blindness due to absence of internal and external ophthalmoplegia

*What is the prognosis?
Good prognosis
It is transient visual loss for few days

*What is the treatment?
Treated conservatively

Q2-50 years old female with head ache and visual disturbance for 20 days duration on gradual progression and of subacute onset, head ache was diffuse, non throbbing, persisted all over the time
The patient is poor controlled diabetic on oral hypoglycemic agents
On examination
-General condition
No jaundice, no anemia, no lymph node enlargement, good hydration
-cranial n.
No relevant find
No parietal lobe signs
No cerebellal signs
No meningeal signs

*What investigations you need?
2-lumber puncture

The investigations show that the patient had elevated I.C.P
Then, emergency lumber peritoneal shunt done
Patient get better regarding head ache and vision
3 months later, symptoms recurrent and after few weeks visual deteriorations occur
On evaluation abdominal catheter was disloged, reimplantation done, the patient also get better but still there is some residual visual disturbance

*What is the investigations we need:
1- lumber puncture
2- abdominal X-ray

The last investigations show normal CSF pressure and normal catheter position
Then , the patient reffered to ophthalmologist for ophthalmological evaluation

*What is the possible ophthalmological causes in this case?
1- atrophic changes
2- diabetic retinopathy

*What is the treatment?
Good blood sugar control

**special thanks to Dr. Saif Anmar (neurosurgeon, M.B.CH.B. ,F.I.C.M.S.) for his great helpness in collect this cases and presented it in this nice picture, from Ibn sina hospital