Neuro-vascular Neuro-ophthalmology (PDF)

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.