My sincerest thanks to Guest Editor Janet C. Rucker, MD, 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.
Neurologic diseases commonly present with abnormalities of vision or eye movement; all neurologists should therefore be well versed in the neuroanatomy, pathophysiology, diagnosis, and management of the many neurologic disorders that include symptoms and signs of neuro-ophthalmic dysfunction. At the same time, neurologists should also have some knowledge of those purely ophthalmic disorders that can resemble primary neurologic or neuro-ophthalmic disorders, especially so as to refer these patients appropriately and expeditiously. Finally, neurologists should have an understanding of the role of specialized neuro-ophthalmologic diagnostic procedures, even those procedures that are not within the typical neurologist’s armamentarium. In this issue of CONTINUUM, Guest Editor Janet C. Rucker, MD, from NYU Langone Medical Center, New York University, along with her assembled group of world-class neuro-ophthalmologist authors and educators, has created a remarkable volume to assist in the evaluation, diagnosis, and management of the many disorders of vision and eye movement that can present to us as neurologists.
The issue begins with a set of articles devoted to the diagnosis, pathophysiology, and management of visual loss. I’m thrilled that Drs Nancy Newman and Valérie Biousse have kicked off this section and this issue by sharing their expertise with us as they provide their diagnostic approach to vision loss in a remarkably thorough, clear, and extensively illustrated article. Dr Fiona Costello next provides an up-to-date review of the diagnosis and management of the inflammatory optic neuropathies that can be seen in primary neurologic disease or as a neurologic complication of systemic disorders. Drs Biousse and Newman again share their expertise with us as they review the diagnosis and management of the retinal and optic nerve ischemic syndromes that can present to neurologists, including a discussion of both the similarities and differences between retinal and cerebral ischemia. In the next article, Dr Deborah I. Friedman discusses the critically important neurologic examination finding of papilledema, as well as the clinical syndrome of idiopathic intracranial hypertension, a disorder for which the results of the very recently reported Idiopathic Intracranial Hypertension Trial, described in her article, now provide the first evidence-based treatment recommendations. Dr Gregory P. Van Stavern provides a clear and encyclopedic review of the diagnosis and management of the many optic neuropathies that are due to metabolic and hereditary etiologies (emphasizing that many of these share a common pathophysiologic pathway of mitochondrial dysfunction), as well as those optic neuropathies with traumatic, neoplastic, and paraneoplastic causes. Dr Christopher C. Glisson next discusses the visual loss caused by the various kinds of lesions that can occur at the optic chiasm and within the retrochiasmal visual pathways. The final contribution to the set of articles devoted to visual loss in this issue is provided by Dr Jason J. S. Barton, who provides an extensive and state-of-the-art review of those complex and fascinating—but unfortunately often quite disabling—visual 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 well-illustrated) 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-eye-movement 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 review—illustrated with carefully chosen examples grouped at the end of the article—of 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 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 neuro-ophthalmic disorders, a discussion of relevance to any neurologist seeing patients with neuro-ophthalmic disease.
As with every Continuum issue, a number of opportunities exist for CME. If you need to earn credits specifically approved by the American Board of Psychiatry and Neurology (ABPN) for self-assessment, submit your answers to the multiple-choice questions in the Self-Assessment 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 Credits™ toward self-assessment. 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 ultimate—and very instructive—diagnosis, 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.
—Steven L. Lewis, MD, FAAN