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Questions and Answers in Neuro-Ophthalmology A Case-Based Approach
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Questions and Answers in Neuro-Ophthalmology A Case-Based Approach Andrew G. Lee MD Houston Methodist Hospital, Houston, TX, USA Chair, Department of Ophthalmology Professor of Ophthalmology, Neurology and Neurosurgery Weill Cornell Medical College, New York City, NY, USA Clinical Professor of Ophthalmology: The University of Texas Medical Branch (UTMB) at Galveston, TX and the UT MD Anderson Cancer Center, Houston, TX, USA Adjunct Professor, Ophthalmology: Baylor College of Medicine and the University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Nagham Al Zubidi MD & Arielle Spitze MD Department of Ophthalmology, Neuro-ophthalmology Section, Houston Methodist Hospital
Sushma Yalamanchili MD Methodist Eye Associates Houston Methodist Hospital Assistant Professor of Ophthalmology Weill Cornell Medical College Adjunct Assistant Professor Department of Ophthalmology and Visual Science The University of Texas Medical Branch (UTMB) at Galveston
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Library of Congress Cataloging-in-Publication Data Lee, Andrew G., author. Questions and answers in neuro-ophthalmology : a case-based approach / Andrew G. Lee, Nagham Al Zubidi, Arielle Spitze. p. ; cm. Includes bibliographical references. ISBN 978-9814578769 (hardcover : alk. paper) -- ISBN 978-9814578776 (pbk. : alk. paper) I. Al Zubidi, Nagham, author. II. Spitze, Arielle, author. III. Title. [DNLM: 1. Cranial Nerve Diseases--Case Reports. 2. Cranial Nerve Diseases--Problems and Exercises. 3. Eye Diseases--Case Reports. 4. Eye Diseases--Problems and Exercises. 5. Eye Manifestations--Case Reports. 6. Eye Manifestations--Problems and Exercises. 7. Neurologic Manifestations--Case Reports. 8. Neurologic Manifestations--Problems and Exercises. WW 18.2] RE49 617.70076--dc23 2013046933
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Copyright © 2014 by World Scientific Publishing Co. Pte. Ltd. All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the publisher.
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Contents Acknowledgments Disclaimer Introduction 1
Anisocoria — Abnormally Small Pupil (Horner Syndrome)
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Arielle Spitze MD, Diana Chao MD, Nagham Al-Zubidi MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 2
Anisocoria — Abnormally Large Pupil
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Arielle Spitze MD, Alexander S. Davis MD, Nagham Al-Zubidi MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 3
Toxic/Nutritional Optic Neuropathy
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Nagham Al-Zubidi MD, Rick N. Nordgren MD, Arielle Spitze MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 4
Optic Disc Drusen
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Nagham Al-Zubidi MD, James D. Kim MD, Arielle Spitze MD, and Andrew G. Lee MD 5
Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)
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Nagham Al-Zubidi MD, Jason Zhang BA, Arielle Spitze MD, Sushma Yalamanchili MD, and Andrew G. Lee MD v
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Non-arteritic Anterior Ischemic Optic Neuropathy (NAION)
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Arteritic Anterior Ischemic Optic Neuropathy (A-AION)
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Arielle Spitze MD, Claudia G. Hooten MD, Nagham Al-Zubidi MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 8
Thyroid Eye Disease
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Arielle Spitze MD, Alexander S. Davis MD, Nagham Al-Zubidi MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 9
Optic Neuritis
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Nagham Al-Zubidi MD, Arielle Spitze MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 10 Third Nerve Palsy
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Arielle Spitze MD, Rabeea Khan MD, Nagham Al-Zubidi MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 11 Fourth Nerve Palsy
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Arielle Spitze MD, Jason Zhang BA, Nagham Al-Zubidi MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 12 Sixth Nerve Palsy
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Nagham Al-Zubidi MD, Rabeea Khan BS, Arielle Spitze MD, Sushma Yalamanchili MD, and Andrew G. Lee MD
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13 Orbital Apex Syndrome
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14 Cavernous Sinus Syndrome
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Arielle Spitze MD, Lauren Jeang BA, Nagham Al-Zubidi MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 15 Arteriovenous Anomalies — Carotid-Cavernous Fistula
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Arielle Spitze MD, Megha Agrawal MD, Nagham Al-Zubidi MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 16 Chiasmal Disorders
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Nagham Al-Zubidi MD, Whitlow Bryan Thomas BS, Arielle Spitze MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 17 Retrochiasmal Lesions
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Nagham Al-Zubidi MD, Pamela C. Carter MD, Arielle Spitze MD, and Andrew G. Lee MD 18 Myasthenia Gravis
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Nagham Al-Zubidi MD, Alexander S. Davis MD, Arielle Spitze MD, Sushma Yalamanchili MD, and Andrew G. Lee MD 19 Nystagmus
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Nagham Al-Zubidi MD, Pamela C. Carter MD, Arielle Spitze MD, and Andrew G. Lee MD 20 Non-Organic Vision Loss
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Nagham Al-Zubidi MD, Bryan Whitlow BS, Arielle Spitze MD, Sushma Yalamanchili MD, and Andrew G. Lee MD
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Acknowledgments Dr. Lee would like to recognize the critical importance of his current and former residents and fellows in conceiving the core idea for this book and for providing the basis for many of the commonly asked questions in neuro-ophthalmology which might be of additional interest to a general ophthalmologist. He also wishes to acknowledge the crucial role of his brother, Richard Lee, in both inspiring and challenging him with his intellectual curiosity and his inquisitive mind and who has been a lifelong source of academic and personal guidance and motivation. In addition, Dr. Lee wishes to give thanks to his professional colleagues, Dr. Neil Miller (Johns Hopkins Hospital), Dr. Tony Arnold (UCLA), and Dr. Paul Brazis (Mayo Clinic), for their wisdom, mentorship, and friendship; to his sister, Amy Lee Wirts MD, for being an equally important and inspirational source of deeper and metaphysical life questions; to his parents, Alberto C. Lee MD and Rosalind L. Go Lee MD, for instilling the tenets of science and medicine in him and for their years of love and support; to his wife, Hilary A. Beaver MD, for her eternal love, companionship, friendship, and patience through the work of nine medical textbooks and 350 papers; and to his children, Rachael E. Lee (aged 11) and Virginia A. Lee (aged 9), whom he hopes will one day assume the mantle of three generations of physicians in the Lee and Beaver families.
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Disclaimer Although Andrew Lee MD is a member of the Ophthalmology Residency Review Committee (RRC), an examiner for the oral board examination of the American Board of Ophthalmology (ABO), and a question writer for the Ophthalmic Knowledge and Assessment Program (OKAP), the questions and answers in this textbook are not designed for the ABO or other board review purposes. The content of the book is the work of the authors alone, who take sole responsibility for the work, and the content does not represent or reflect the views of the RRC, ABO, or OKAP in any way.
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Introduction This book is designed to answer the routine and common questions of medical students, residents, fellows, and general ophthalmologists about garden-variety topics in neuro-ophthalmology. It is not intended to be all-inclusive or comprehensive and instead is meant to challenge readers to consider the distinctive symptoms, differentiating signs, and distinguishing radiographic or laboratory features of common neuroophthalmic problems. Other reference sources can provide more in-depth analysis or detail for anatomy, pathogenesis, or other basic science content for these conditions. Our intention is simply to provide a starting point for clinicians interested in the key clinical history, examination, laboratory, or radiographic findings in these common neuro-ophthalmic presentations. We hope that you will take the opportunity to write and answer your own questions for these and other topics as the process itself of reading and writing questions is an additional mechanism to leverage your lifelong learning in neuroophthalmology.
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