Neuro-vascular Neuro-ophthalmology

Neuro-ophthalmological symptoms frequently arise in disorders which alter the intracranial and intraorbital circulation. Because of the wide range of sensory and cognitive systems involved in vision and eye movements, visual disturbances are typically found in the common vascular disorders, such as atherosclerosis, migraine, and aneurysms, but can also result from practically any, common or rare, local or systemic vascular disorder. The dysfunction can be part of a largersyndrome or the predominant clinical abnormality. Many of the newer concepts concerning the diagnosis and treatment of neurovascular disorders have evolved in consequence of advances in techniques for neuroimaging such as MRI; methods of measuring systemic coagulation and inflammation; and superselective catheterization ofabnormal blood vessels and vascular lesions. The neuroophthalmological evaluation of clinical signs and symptoms often leads to accurate localization and diagnosis of the lesion. Many of these clinical abnormalities, such as visual field defects and ocular misalignments, can be quantified and followed to assess either the natural history of the disorder or the effects of therapies. No one medical specialty can manage these neurovascular neuro-ophthalmological disorders alone. The complexity of diagnosis and treatment planning requires a multi- disciplinary team. This approach, bringing ophthalmologists, neurosurgeons, and neurologists together to confer in the management of these cases, has been pioneered by the authors' group at the New York University Medical Center.

Table of Contents:
1 Circulation of the Eye, Orbit, Cranial Nerves, and Brain.- 1.1 Introduction.- 1.2 Carotid Arterial System.- 1.3 Vertebrobasilar Arterial System.- 1.4 Intracranial Venous Drainage.- 1.5 Circulation in Regions of Neuro-ophthalmologic Importance.- 1.6 Cerebral Blood Flow Physiology.- 2 Carotid Cavernous Fistulas.- 2.1 Epidemiology and Causes.- 2.2 Clinical Presentation, Evaluation, and Differential Diagnosis.- 2.3 Laboratory Evaluation.- 2.4 Therapy.- 3 Neuro-ophthalmic Manifestations of Intracranial Dural Venous Disorders.- 3.1 Introduction.- 3.2 Dural Arteriovenous Malformations and Shunts.- 3.3 Dural Venous Sinus Thrombosis.- 4 Orbital Vascular Lesions.- 4.1 Introduction.- 4.2 Clinical Evaluation of Patients with Orbital Disease.- 4.3 Imaging of Orbital Lesions.- 4.4 Orbital Varix.- 4.5 Arteriovenous Malformation.- 4.6 Capillary Hemangioma.- 4.7 Cavernous Hemangioma (Cavernoma).- 4.8 Lymphangioma.- 4.9 Hemangiopericytoma.- 4.10 Malignant Hemangioendothelioma.- 4.11 Leiomyoma.- 4.12 Vascular Tumors of the Sphenoid Wing and the Cavernous Sinus.- 4.13 Vascular Phakomatoses (Neurocutaneous Syndromes).- 4.14 Cavernous Hemangioma of the Brain and Retina.- 5 Vascular Optic Neuropathies.- 5.1 Anterior Ischemic Optic Neuropathy.- 5.2 Giant-Cell Arteritis.- 5.3 Papilledema.- 5.4 Leber’s Optic Neuropathy.- 5.5 Postshock Optic Neuropathy.- 5.6 Low-Tension Glaucoma.- 5.7 Juvenile Diabetes Mellitus.- 5.8 Optic Disc Vasculities or Papillophlebitis.- 5.9 Posterior Ischemic Optic Neuropathy.- 5.10 Rare Causes of Ischemic Optic Neuropathy.- 5.11 Radiation Damage to the Eye and Brain.- 6 Aneurysms Involving the Motor and Sensory Visual Pathways.- 6.1 General Discussion.- 6.2 Carotid Cavernous Aneurysm.- 6.3 Posterior Communicating Artery Aneurysm.- 6.4 Carotid-Ophthalmic ArteryAneurysm.- 6.5 Aneurysm of the Internal Carotid Artery Bifurcation.- 6.6 Anterior Communicating Artery Aneurysm.- 6.7 Basilar Artery Aneurysm.- 6.8 Other Posterior Circulation Aneurysms.- 6.9 Nonsaccular Aneurysms.- 7 Vascular Malformations of the Brain.- 7.1 Arteriovenous Malformations.- 7.1.11 Treatment.- 7.2 Other Vascular Lesions of the Brain.- 8 Embolic and Noninflammatory Occlusive Vascular Disease of the Visual and Ocular Motor Systems.- 8.1 Introduction.- 8.2 Ocular Ischemia.- 8.3 Carotid and Cardiac Evaluation.- 8.4 Aortic Arch Occlusive Disease.- 8.5 Neuro-ophthalmologic Disorders Caused by Brain Infarcts.- 8.6 Therapeutic Considerations.- 8.7 Atypical Occlusive Disease of the Ophthalmic Artery.- 8.8 Ischemic Cranial Nerve Syndromes.- 8.9 Fibromuscular Dysplasia.- 8.10 Moyamoya Disease.- 8.11 Hypercoagulation Disorders.- 8.12 Dissection of the Carotid and Vertebral Arteries.- 8.13 Metabolic Disorders Associated with Cerebral Vaso-occlusive Disease.- 8.14 Specific Retinal Disorders.- 9 Inflammatory Vascular Disorders of the Brain and Eye.- 9.1 Introduction.- 9.2 Giant Cell Arteritis (Temporal Arteritis).- 9.3 Polyarteritis Nodosa.- 9.4 Systemic Lupus Erythematosus.- 9.5 Rheumatoid Arthritis.- 9.6 Wegener’s Granulomatosis.- 9.7 Behçet’s Syndrome.- 9.8 Granulomatous Angiitis Confined to the Central Nervous System.- 9.9 Central Nervous System Angiitis of Other Causes.- 9.10 Takayasu’s Arteritis.- 9.11 Cogan’s Syndrome.- 9.12 Lymphatoid Granulomatosis.- 9.13 Microangiopathy of the Retina and Brain.- 9.14 Eales’ Disease (Periphlebitis Retinae).- 9.15 Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Cerebral Vasculities.- 9.16 Sjögren’s Syndrome.- 9.17 Occlusive Disease Associated with Antiphospholipid Antibody Syndromes: A Disorder inEvolution.- 10 Migraine.- 10.1 Introduction and Epidemiology.- 10.2 Types of Migraine.- 10.3 Theories of the Causes of Migraine.- 10.4 Theories of Visual and Neurologic Phenomena.- 10.5 Mechanisms of Headache.- 10.6 Laboratory Evaluation.- 10.7 Treatment.- References.