Clinical Briefing:
Penn's Neuro-Ophthalmology Service
January/February 2008
The Penn
Neuro-Ophthalmology Service
bridges the fields of ophthalmology and
neurology to
provide diagnosis and treatment for patients with neurological and systemic
diseases that affect vision and eye movements.
A part of the renowned Scheie
Eye Institute and Penn
Neurological Institutes,
the Penn Neuro-Ophthalmology Service is the largest of its
kind in the nation. Penn’s fellowship-trained neuro-ophthalmologists work
in concert with specialists in ophthalmology, neurology,
neurosurgery, otorhinolaryngology and neuro-radiology to
achieve a comprehensive approach to disease evaluation, diagnosis,
and treatment.
The team has
extensive experience with all forms of neuro-ophthalmic disease,
including double vision, optic neuropathy, pupillary abnormalities,
visual field defects, nystagmus, and visual defects related
to neoplastic disease.
Case Study
L.V., a 36-year old woman, was evaluated for acute visual
loss and abduction deficits. Between age 20 to 24, she
had eight lumboperitoneal shunt revisions for treatment
of pseudotumor cerebri. Three months prior to presentation
she experienced headaches, blurred vision, and nausea.
One
month prior to presentation her vision and optic nerve appearance
was normal. She then developed a constant severe headache
and neck pain and vision loss that worsened over several
days. Upon examination, she had no light perception vision
in the right eye, 20/70 visual acuity and a large nasal
visual field defect in the left eye.
In addition, bilateral
sixth nerve palsies, and severe pallid papilledema with
peripapillary hemorrhages and venous distension were evident
(Fig. right eye before). Magnetic resonance imaging (MRI)
of the brain was normal. Lumbar puncture opening pressure
was markedly elevated at 550 mm H20 (nl < 250 mm H20).
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Photographs of optic nerve papilledema before (left) and after
(right) fenestration. |
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A diagnosis of severe acute vision loss due to pseudotumor cerebri and
lumboperitoneal shunt failure was made. Intravenous methylprednisolone
and acetazolamide were administered immediately. Optic nerve sheath fenestration
was then performed on the right optic nerve, and the lumboperitoneal
shunt was externalized. A malfunctioning valve was discovered when the
shunt was revised. Postoperatively, the steroids and azetazolamide were discontinued.
The patient’s vision improved rapidly. Two weeks later the papilledema
had almost resolved (Fig. right eye after), and visual acuity was 20/20 in both
eyes with residual infranasal constriction of the visual fields of each eye.
Our Team of Faculty
The Scheie Eye Institute and Penn Neurological Institute
offer complete diagnostic and treatment services in comprehensive and
subspecialty ophthalmology and neurology. The breadth of expertise
and experience in the Penn Division of Neuro-Ophthalmology provides
a comprehensive network of care for patients with complex conditions
that span both neurology and ophthalmology.
Our team is also
leading the development of novel therapies for neuro-ophthalmic
diseases through cutting-edge clinical and basic science research
studies, teaching, and residency and fellowship training.
Steven L. Galetta, MD
Chief, Neuro-Ophthalmology Division
Van Meter Professor of Neurology and Ophthalmology
Laura J. Balcer, MD, MSCE
Associate Professor of Neurology and Ophthalmology
Dina Jacobs, MD
Assistant Professor of Neurology
Grant T. Liu, MD
Professor of Neurology and Ophthalmology
Kenneth S. Shindler, MD, PhD
Assistant Professor of Ophthalmology
Madhura Tamhankar, MD
Assistant Professor of Ophthalmology
Nicholas J. Volpe, MD
Adele Niessen Professor of Ophthalmology and Neurology
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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