Acute Visual Disturbances

  • Cédric Lamirel
  • Nancy J. Newman
  • Valérie BiousseEmail author


The visual pathways traverse more than one-third of the brain, explaining why visual function is frequently affected by intracranial lesions and a wide range of neurological disorders. Visual disturbances such as monocular or binocular visual loss, visual hallucinations and diplopia may reveal a neurological disorder. Correct interpretation and evaluation of these visual changes may prevent further devastating neurological complications.


  1. 1.
    Biousse V, Newman N. Neuro-ophthalmology illustrated. New York: Thieme; 2009.Google Scholar
  2. 2.
    Trobe J. The neurology of vision. Oxford: Oxford University Press; 2001.Google Scholar
  3. 3.
    Robinett DA, Kahn JH. The physical examination of the eye. Emerg Med Clin North Am. 2008;26:1–16.CrossRefGoogle Scholar
  4. 4.
    Atkins EJ, Newman NJ, Biousse V. Post-traumatic visual loss. Rev Neurol Dis. 2008;5:73–81.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Bord SP, Linden J. Trauma to the globe and orbit. Emerg Med Clin North Am. 2008;26:97–123, vi–viiCrossRefGoogle Scholar
  6. 6.
    Dargin JM, Lowenstein RA. The painful eye. Emerg Med Clin North Am. 2008;26:199–216, viiiCrossRefGoogle Scholar
  7. 7.
    Mueller JB, McStay CM. Ocular infection and inflammation. Emerg Med Clin North Am. 2008;26:57–72, viCrossRefGoogle Scholar
  8. 8.
    Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin North Am. 2008;26:35–55, viCrossRefGoogle Scholar
  9. 9.
    Vortmann M, Schneider JI. Acute monocular visual loss. Emerg Med Clin North Am. 2008;26:73–96, viCrossRefGoogle Scholar
  10. 10.
    Biousse V, Mendicino ME, Simon DJ, et al. The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol. 1998;125:527–44.CrossRefGoogle Scholar
  11. 11.
    Kaufman SR. Developments in age-related macular degeneration: diagnosis and treatment. Geriatrics. 2009;64:16–9.PubMedGoogle Scholar
  12. 12.
    Miller NR, Newman NJ. The eye in neurological disease. Lancet. 2004;364:2045–54.CrossRefGoogle Scholar
  13. 13.
    Biousse V. Cerebrovascular disease. In: Miller M, Newman N, Biousse V, Kerrison J, editors. Clinical neuro-ophthalmology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 1967–2168.Google Scholar
  14. 14.
    Melson MR, Weyand CM, Newman NJ, et al. The diagnosis of giant cell arteritis. Rev Neurol Dis. 2007;4:128–42.PubMedGoogle Scholar
  15. 15.
    Hall JK. Giant-cell arteritis. Curr Opin Ophthalmol. 2008;19:454–60.CrossRefGoogle Scholar
  16. 16.
    Luneau K, Newman NJ, Biousse V. Ischemic optic neuropathies. Neurologist. 2008;14:341–54.CrossRefGoogle Scholar
  17. 17.
    Atkins EJ, Bruce BB, Newman NJ, et al. Treatment of nonarteritic anterior optic neuropathy. Surv Ophthalmol. 2010;55:47–63.CrossRefGoogle Scholar
  18. 18.
    Hayreh SS, Zimmerman MB. Optic disc edema in non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol. 2007;245:1107–21.CrossRefGoogle Scholar
  19. 19.
    Dickersin K, et al. Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. The Ischemic Optic Neuropathy Decompression Trial Research Group. JAMA. 1995;273:625–32.CrossRefGoogle Scholar
  20. 20.
    Preechawat P, Bruce BB, Newman NJ, et al. Anterior ischemic optic neuropathy in patients younger than 50 years. Am J Ophthalmol. 2007;144:953–60.CrossRefGoogle Scholar
  21. 21.
    Fraser JA, Weyand CM, Newman NJ, et al. The treatment of giant cell arteritis. Rev Neurol Dis. 2008;5:140–52.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Hayreh SS, Biousse V. Treatment of acute visual loss in giant cell arteritis: should we prescribe high-dose intravenous steroids or just oral steroids. J Neuroophthalmol. 2012;32:278–87.CrossRefGoogle Scholar
  23. 23.
    Atkins EJ, Biousse V, Opticneuritis NNJ. Semin Neurol. 2007;27:211–20.CrossRefGoogle Scholar
  24. 24.
    Atkins EJ, Biousse V, Newman NJ. The natural history of optic neuritis. Rev Neurol Dis. 2006;3:45–56.PubMedGoogle Scholar
  25. 25.
    Weinshenker BG, Wingerchuk DM, Vukusic S, et al. Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis. Ann Neurol. 2006;59:566–9.CrossRefGoogle Scholar
  26. 26.
    Giovannoni G. To test or not to test: NMO-IgG and optic neuritis. Neurology. 2008;70:2192–3.CrossRefGoogle Scholar
  27. 27.
    The Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up. Arch Neurol. 2008;65:727–32.PubMedCentralGoogle Scholar
  28. 28.
    Purvin VA, Chioran G. Recurrent neuroretinitis. Arch Ophthalmol. 1994;112:365–71.CrossRefGoogle Scholar
  29. 29.
    Nordic idiopathic intracranial hypertension study group writing committee, Wall M, MP MD, et al. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA. 2014;311:1641–51.CrossRefGoogle Scholar
  30. 30.
    Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002;59:1492–5.CrossRefGoogle Scholar
  31. 31.
    Thambisetty M, Lavin PJ, Newman NJ, et al. Fulminant idiopathic intracranial hypertension. Neurology. 2007;68:229–32.CrossRefGoogle Scholar
  32. 32.
    Newman NJ. Hereditary optic neuropathies: from the mitochondria to the optic nerve. Am J Ophthalmol. 2005;140:517–23.PubMedGoogle Scholar
  33. 33.
    Fraser JA, Biousse V, Newman NJ. The neuro-ophthalmology of mitochondrial disease. Surv Ophthalmol. 2010;55:299–334.CrossRefGoogle Scholar
  34. 34.
    Zhang X, Kedar S, Lynn MJ, et al. Homonymous hemianopias: clinical–anatomic correlations in 904 cases. Neurology. 2006;66:906–10.CrossRefGoogle Scholar
  35. 35.
    Bruce BB, Zhang X, Kedar S, et al. Traumatic homonymous hemianopia. J Neurol Neurosurg Psychiatry. 2006;77:986–8.CrossRefGoogle Scholar
  36. 36.
    Zhang X, Kedar S, Lynn MJ, et al. Homonymous hemianopia in stroke. J Neuroophthalmol. 2006;26:180–3.CrossRefGoogle Scholar
  37. 37.
    Zhang X, Kedar S, Lynn MJ, et al. Natural history of homonymous hemianopia. Neurology. 2006;66:901–5.CrossRefGoogle Scholar
  38. 38.
    Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29:1036–42.CrossRefGoogle Scholar
  39. 39.
    Biousse V, Trobe JD. Transient monocular visual loss. Am J Ophthalmol. 2005;140:717–21.CrossRefGoogle Scholar
  40. 40.
    Benavente O, Eliasziw M, Streifler JY, et al. Prognosis after transient monocular blindness associated with carotid-artery stenosis. N Engl J Med. 2001;345:1084–90.CrossRefGoogle Scholar
  41. 41.
    Lavallée PC, Cabrejo L, Labreuche J, et al. Spectrum of transient visual symptoms in a transient ischemic attack cohort. Stroke. 2013;44:3312–7.CrossRefGoogle Scholar
  42. 42.
    Bhatti MT. Orbital syndromes. Semin Neurol. 2007;27:269–87.CrossRefGoogle Scholar
  43. 43.
    Luchanok U, Kaminski HJ. Ocular myasthenia: diagnostic and treatment recommendations and the evidence base. Curr Opin Neurol. 2008;21:8–15.CrossRefGoogle Scholar
  44. 44.
    Bruce BB, Biousse V, Newman NJ. Third nerve palsies. Semin Neurol. 2007;27:257–68.CrossRefGoogle Scholar
  45. 45.
    Biousse V, Newman NJ. Aneurysms and subarachnoid hemorrhage. Neurosurg Clin North Am. 1999;10:631–51.CrossRefGoogle Scholar
  46. 46.
    Elmalem VI, Hudgins PA, Bruce BB, et al. Underdiagnosis of posterior communicating artery aneurysm in noninvasive brain vascular studies. J Neuroophthalmol. 2011;31:103–9.CrossRefGoogle Scholar
  47. 47.
    Brazis PW. Isolated palsies of cranial nerves III, IV, and VI. Semin Neurol. 2009;29:14–28.CrossRefGoogle Scholar
  48. 48.
    Dembek ZF, Smith LA, Rusnak JM. Botulism: cause, effects, diagnosis, clinical and laboratory identification, and treatment modalities. Disaster Med Public Health Prep. 2007;1:122–34.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Cédric Lamirel
    • 1
  • Nancy J. Newman
    • 1
  • Valérie Biousse
    • 1
    Email author
  1. 1.Neuro-Ophthalmology Unit, Emory Eye CenterAtlantaUSA

Personalised recommendations