Ocular Presentation in Diseases of Central Nervous System - MBBS Lecture

Ophthalmologist Dr. Sanjeev Kumar Mittal from AIIMS Rishikesh discusses the ocular manifestations of intracranial lesions, emphasizing the importance of early diagnosis by ophthalmologists. Symptoms include headaches, vision changes, seizures, and more, while signs may include visual field defects, papilledema, and cranial nerve palsies. The lecture highlights the crucial role ophthalmologists play in detecting and referring patients with CNS-related eye issues.

• Ocular Presentation
• Central Nervous System
• Ophthalmology
• Intracranial Lesions
• Medical Lecture

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1. Ocular Presentation in Diseases of central Nervous system MBBS Lecture Dated 28-02-2018 Dr. Sanjeev Kumar Mittal Professor & Head, Dept of Ophthalmology All India Institute of Medical Sciences, Rishikesh

2. INTRODUCTION INTRODUCTION Intracranial lesions may cause: -serious ocular signs and symptoms -neurological complications (raised ICT) -cranial nerve impairment or brain compression 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

3. INTRODUCTION Intracranial lesions may cause: -serious ocular signs and symptoms -neurological complications (raised ICT) -cranial nerve impairment or brain compression >50 % - present to an ophthalmologist initially 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

4. INTRODUCTION Intracranial lesions may cause: -serious ocular signs and symptoms -neurological complications (raised ICT) -cranial nerve impairment or brain compression >50 % - present to an ophthalmologist initially Ophthalmologists play a vital role in early diagnosis and proper referral. 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

5. HOW DO THE PATIENT PRESENT ? 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

6. CLINICAL PRESENTATION SYMPTOMS: Headache Diminution of Vision Seizures Behavioural and psychiatric changes Vertigo Paresis Dysphasia, dementia, deafness, tinnitus, ataxia, and diplopia etc. 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

7. CLINICAL PRESENTATION SIGNS(one or more of following depending upon location and size) Vision Visual field defects Proptosis Pupillary defect Papilloedema Optic atrophy 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

8. CLINICAL PRESENTATION SIGNS: Nystagmus Gaze palsy Paralytic squint [Cranial Nerve palsies-VI, VII, IV] 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

9. Intracranial lesions MENINGITIS ENCEPHALITIS BRAIN ABSCESS NEUROSYPHILIS INFECTIONS 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

10. Intracranial lesions INTRACRANIAL ANEURYSMS ISCHEMIC AND CIRCULATORY DISORDERS CEREBRAL ISCHEMIA AND HAEMORRAHGES HYDROCEPHALOUS 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

11. INTRACRANIAL ANEURYSMS- 2 to 3 % in the region of circle of willis 1. Congenital weakness in the wall 2. Post traumatic 3. Post infection Carotico-cavernous fistula 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

12. CEREBRAL ISCHEMIA AND HAEMORRAHGES Transient ischaemic attacks Cerebral strokes Intra cerebral hematoma Sub arachnoid haemorrhage 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

13. HYDROCEPHALOUS Congenital acquired 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

14. Intracranial lesions MULTIPLE SCLEROSIS DEMYLENATING LESIONS NEUROMYELITIS OPTICA SCHILDER'S DISEASE 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

15. MULTIPLE SCLEROSIS Loss of sensory or motor function of different parts of body Optic neuritis Sudden DV 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

16. NEUROMYELITIS OPTICA Bilateral Optic neuritis with Lumbar / thoracic myelitis 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

17. SCHILDER'S DISEASE, DIFFUSE SCLEROSIS OPTIC RADIATION, RBN, Muscle palsy, Nystagmus 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

18. Chronic Progressive Ophthalmoplegia friedreich s disease [hereditary ataxia] 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

19. Intracranial lesions CONCUSSION INJURY TO BRAIN HEAD INJURY CEREBRAL CONTUSION FRACTURE BASE OF SKULL 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

20. Intracranial lesions PRIMARY OPTIC TUMOURS SECONDARY TUMOURS ICSOLS HAMETOGENOUS LESION GRANULOMATOUS LESION PARASITIC CYST 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

21. most common types in adults pituitary adenoma meningioma craniopharyngioma 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

22. DIFFERENTIAL DIAGNOSIS OF ICSOL OCULAR FEATURES Frontal lobe tumours(gliomas, meningiomas) 1 Slight bulging of eye ball (ipsilateral).If extension into chiasm -foster kennedy syndrome ,papilloedema,optic atrophy,psychic changes, Alteration in character and temperament Frontal lobe and optic nerve pushed up(simulates pituitary tumour) Olfactory groove tumours (meningiomas) 2 Sphenoidal ridge tumours (meningiomas) 3 Proptosis Pituitary tumours (adenomas) 4 Optic nerve ischemia then atrophy, Bitemporal heminopia, Colour field defective Suprasellar (Rathke s pouch) tumours (craniopharyngioma) Median area tumours (Meningiomas) 5 Papilloedema, diplopia(VI nerve involvement 6 Paralysis of V.VI,VII ,Homonymous hemianopia, Papilloedema Temporal lobe tumours (Gliomas, meningiomas) Occipital tumours 7 Contralateral homonymous hemianopia(Incongruous) 8 Congruous field defects Cerebellar tumours (medulloblastoma) 9 Coarse horizontal nystagmus,Bilateral papilledema,diplopia(VI nerve palsy) Paralysis of V.VI,VII 10 Cerebellopontine angle tumours (Neuromas, neurofibromas, or gliomas in connection with acoustic and vestibular nerves) 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

23. Extra-ocular disturbances. (a) Sensory. (b) Motor. (c) Psychic (d) Endocrinal. 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

24. HOW DO WE CLINICALLY APPROACH........ 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

25. CLINICAL APPROACH HISTORY......v.v important Presenting complaint Past Family Personal habits OPHTHALMOLOGICAL: Vision (BCVA) Visual fields and colour perception Pupillary reflexes Displacement of the eyeball. 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

26. CLINICAL APPROACH Extraocular movements(gaze palsy, paralytic squint or nystagmus) Dilated fundus examination with IO( papilloedema, papillitis, optic nerve atrophy, retinal haemorrages, arteritis, atherosclerotic changes ,etc..) 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

27. HOW TO INVESTIGATE...??? 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

28. investigations BASELINE CBC with ESR URINE ROUTINE AND MICROSCOPY Special Investigations- MRI brain with orbit CT scan Fundus flurorescein angiography B- scan VER 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

29. investigations And other special investigations(if needed): Viral markers Mantoux test for Tuberculosis CSF analysis VDRL for syphilis Orbital biopsy FNAC of lesion X-Rays if needed Angiography Doppler ultrasonography 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

30. Summary Detailed neuro- ophthalmic evaluation Judicious use of neuroimag ing CORRECT DIAGNOSIS and Careful history Investigations TREATMENT 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

31. Source Text-Kanski, Parson s, Samar Basak, Pradeep Sharma Photographs- above , Archives & Website 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh

32. The End 30-09-2024 Dr.Sanjeev Kumar Mittal,AIIMS Rishikesh