As in any field of medicine, the neuro-ophthalmic history guides the physician’s examination and differential diagnosis. From the beginning of the history taking, the physician should attempt to categorize the patient’s problem. Table 1.1 , which mirrors the organization of this book, classifies neuro-ophthalmic disorders into three groups: afferent disorders, efferent disorders, and headache and abnormal facial sensations. It can be used as a guide in generating a differential diagnosis. Then, influenced by the patient’s age, gender, underlying illnesses, and disease risk factors, the physician can narrow the list of potential diagnoses and shape the examination to confirm or eliminate each disorder.
| Chapter | |
|---|---|
| VISUAL LOSS AND OTHER DISORDERS OF THE AFFERENT VISUAL PATHWAY | |
| Visual loss: retinal disorders | 4 |
| Visual loss: optic neuropathies | 5 |
| Optic disc swelling: papilledema and other causes | 6 |
| Visual loss: chiasmal disorders | 7 |
| Visual loss: retrochiasmal disorders | 8 |
| Disorders of higher cortical visual function | 9 |
| Transient visual loss | 10 |
| Functional visual loss | 11 |
| Visual hallucinations and illusions | 12 |
| EFFERENT NEURO-OPHTHALMIC DISORDERS | |
| Pupillary disorders | 13 |
| Eyelid and facial nerve disorders | 14 |
| Eye movement disorders: third, fourth, and sixth nerve palsies and other causes of diplopia and ocular misalignment | 15 |
| Eye movement disorders: gaze abnormalities | 16 |
| Eye movement disorders: nystagmus and nystagmoid eye movements | 17 |
| Orbital disease | 18 |
| HEADACHE, FACIAL PAIN, AND DISORDERS OF FACIAL SENSATION | 19 |
As the clinician gains experience and sophistication, he or she can frequently diagnose the correct neuro-ophthalmic disorder based on the history alone. For instance, an otherwise healthy young woman with sudden vision loss in one eye with pain on eye movements probably has optic neuritis. An elderly man with hypertension, new binocular horizontal double vision worse at distance and in right gaze, and right periorbital pain most likely has a vasculopathic right sixth nerve palsy.
This chapter reviews the various elements of the neuro-ophthalmic history ( Box 1.1 ) in the context of neuro-ophthalmic disorders. Electronic medical record (EMR) technology allows templates to be constructed using these elements to guide the history taking. However, clinicians should avoid simply cutting and pasting, which is tempting with EMRs, and ensure that the history tells a story.
Chief complaint
Age, gender, and major complaint
History of present illness
Detailing the problem
Temporal profile of symptoms
Associated symptoms
Past neurologic and ophthalmic history
Past medical and surgical history
Review of systems
Family history
Social history
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