Neuro-ophthalmologic Emergencies

  • James L. Webb
  • Brit Long


Neuro-ophthalmologic emergencies consist of neurologic disorders with ocular involvement. These conditions often require urgent imaging, consultation, and treatment. The ophthalmologic presentation along with associated features can guide the emergency physician in localizing the underlying process and subsequent management. This chapter evaluates these conditions, with associated emergency evaluation and management.


Ophthalmology Neuro-ophthalmology Examination History 


  1. 1.
    Walker RA, Adhikaris. Eye emergencies. In: Tintinalli’s emergency medicine: a comprehensive study guide. 8th ed. Columbus: Mcgraw-Hill; 2016. Chap. 241.Google Scholar
  2. 2.
    Huff JS, Austin EW. Neuro-ophthalmology in emergency medicine. Emerg Med Clin North Am. 2016;34:967–86.CrossRefPubMedGoogle Scholar
  3. 3.
    Cordonnier M, Van Nechel C. Neuro-ophthalmological emergencies: which ocular signs or symptoms for which diseases? Acta Neurol Belg. 2013;113:215–24.CrossRefPubMedGoogle Scholar
  4. 4.
    Graves JS, Galetta SL. Acute visual loss and other neuro-ophthalmologic emergencies: management. Neurol Clin. 2012;30:75–99.CrossRefPubMedGoogle Scholar
  5. 5.
    Zhang X, Kedar S, Lynn MJ, et al. Homonymous hemianopias: clinical-anatomic correlations in 904 cases. Neurology. 2006;66:906.CrossRefPubMedGoogle Scholar
  6. 6.
    Kawasaki A, Purvin V. Giant cell arteritis: an updated review. Acta Ophthalmol. 2009;87:13–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Smetana GW, Shmerling RH. Does this patient have temporal arteritis? JAMA. 2002;287:92–101.CrossRefPubMedGoogle Scholar
  8. 8.
    Biousse V, Newman NJ. Ischemic optic neuropathies. N Engl J Med. 2015;372:2428–36.CrossRefPubMedGoogle Scholar
  9. 9.
    Balcer LJ. Clinical practice. Optic neuritis. N Engl J Med. 2006;354:1273–80.CrossRefPubMedGoogle Scholar
  10. 10.
    Arnold AC. Evolving management of optic neuritis and multiple sclerosis. Am J Ophthalmol. 2005;139:1101–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Golnik KC. Infectious optic neuropathy. Semin Ophthalmol. 2002;17:11–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Hollands H, Johnson D, Brox AC, et al. Acute-onset floaters and flashes: is this patient at risk for retinal detachment? JAMA. 2009;302:2243–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Charles A. Advances in the basic and clinical science of migraine. Ann Neurol. 2009;65:491–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Cutrer FM, Huerter K. Migraine aura. Neurologist. 2007;13:118–25.CrossRefPubMedGoogle Scholar
  15. 15.
    Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry. 2005;76(Suppl 1):i2–12.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Beatty S. Non-organic visual loss. Postgrad Med J. 1999;75:201–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Lee SH, Lee SS, Park KY, Han SH. Isolated oculomotor nerve palsy: diagnostic approach using the degree of external and internal dysfunction. Clin Neurol Neurosurg. 2002;104:136.CrossRefPubMedGoogle Scholar
  18. 18.
    Chaudhary N, Davagnanam I, Ansari SA, et al. Imaging of intracranial aneurysms causing isolated third cranial nerve palsy. J Neuroophthalmol. 2009;29:238–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Walton KA, Buono LM. Horner syndrome. Curr Opin Ophthalmol. 2003;14:357–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Bone I, Hadley DM. Syndromes of the orbital fissure, cavernous sinus, cerebello-pontine angle, and skull base. J Neurol Neurosurg Psychiatry. 2005;76(Suppl 3):iii29–38.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Ebright JR, Pace MT, Niazi AF. Septic thrombosis of the cavernous sinuses. Arch Intern Med. 2001;161:2671–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Randeva HS, Schoebel J, Byrne J, et al. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol. 1999;51:181–8.CrossRefGoogle Scholar
  23. 23.
    Capatina C, Inder W, Karavitaki N, Wass JA. Management of endocrine disease: pituitary tumour apoplexy. Eur J Endocrinol. 2015;172:R179–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Arafah BM, Harrington JF, Madhoun ZT, Selman WR. Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J Clin Endocrinol Metab. 1990;71:323–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Wall M, Kupersmith MJ, Kieburtz KD, et al. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol. 2014;71:693–701.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Biousse V, Bruce BB, Newman NJ. Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry. 2012;83:488–94.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Silvestri NJ, Wolfe GI. Myasthenia gravis. Semin Neurol. 2012;32:215–26.CrossRefPubMedGoogle Scholar
  28. 28.
    Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol. 2009;8:475.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Donnino MW, Vega J, Miller J, Walsh M. Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know. Ann Emerg Med. 2007;50:715–21.CrossRefPubMedGoogle Scholar
  30. 30.
    Galvin R, Bråthen G, Ivashynka A, et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010;17:1408–18.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • James L. Webb
    • 1
  • Brit Long
    • 2
  1. 1.San Antonio Uniformed Services Health Education ConsortiumSan AntonioUSA
  2. 2.San Antonio Military Medical Center, Department of Emergency MedicineSan AntonioUSA

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