1
|
Maciag EJ, Martín-Noguerol T, Ortiz-Pérez S, Torres C, Luna A. Understanding Visual Disorders through Correlation of Clinical and Radiologic Findings. Radiographics 2024; 44:e230081. [PMID: 38271255 DOI: 10.1148/rg.230081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Patients presenting with visual disturbances often require a neuroimaging approach. The spectrum of visual disturbances includes three main categories: vision impairment, ocular motility dysfunction, and abnormal pupillary response. Decreased vision is usually due to an eye abnormality. However, it can also be related to other disorders affecting the visual pathway, from the retina to the occipital lobe. Ocular motility dysfunction may follow disorders of the cranial nerves responsible for eye movements (ie, oculomotor, trochlear, and abducens nerves); may be due to any abnormality that directly affects the extraocular muscles, such as tumor or inflammation; or may result from any orbital disease that can alter the anatomy or function of these muscles, leading to diplopia and strabismus. Given that pupillary response depends on the normal function of the sympathetic and parasympathetic pathways, an abnormality affecting these neuronal systems manifests, respectively, as pupillary miosis or mydriasis, with other related symptoms. In some cases, neuroimaging studies must complement the clinical ophthalmologic examination to better assess the anatomic and pathologic conditions that could explain the symptoms. US has a major role in the assessment of diseases of the eye and anterior orbit. CT is usually the first-line imaging modality because of its attainability, especially in trauma settings. MRI offers further information for inflammatory and tumoral cases. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
- Ewa J Maciag
- From the Department of Radiology, MRI Unit, SERCOSA, HT médica, Clínica Las Nieves, Carmelo Torres 2, 23007 Jaén, Spain (E.J.M., T.M.N., A.L.); Department of Ophthalmology, Hospital Virgen de las Nieves, Granada, Spain (S.O.P.); Department of Ophthalmology, Facultad de Medicina, Universidad de Granada, Spain (S.O.P.); Granada Vision and Eye Research Team, Instituto de Investigación Biosanitaria IBS, Granada, Spain (S.O.P.); Department of Radiology, Radiation Oncology, and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada (C.T.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (C.T.); and Ottawa Hospital Research Institute OHRI and Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada (C.T.)
| | - Teodoro Martín-Noguerol
- From the Department of Radiology, MRI Unit, SERCOSA, HT médica, Clínica Las Nieves, Carmelo Torres 2, 23007 Jaén, Spain (E.J.M., T.M.N., A.L.); Department of Ophthalmology, Hospital Virgen de las Nieves, Granada, Spain (S.O.P.); Department of Ophthalmology, Facultad de Medicina, Universidad de Granada, Spain (S.O.P.); Granada Vision and Eye Research Team, Instituto de Investigación Biosanitaria IBS, Granada, Spain (S.O.P.); Department of Radiology, Radiation Oncology, and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada (C.T.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (C.T.); and Ottawa Hospital Research Institute OHRI and Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada (C.T.)
| | - Santiago Ortiz-Pérez
- From the Department of Radiology, MRI Unit, SERCOSA, HT médica, Clínica Las Nieves, Carmelo Torres 2, 23007 Jaén, Spain (E.J.M., T.M.N., A.L.); Department of Ophthalmology, Hospital Virgen de las Nieves, Granada, Spain (S.O.P.); Department of Ophthalmology, Facultad de Medicina, Universidad de Granada, Spain (S.O.P.); Granada Vision and Eye Research Team, Instituto de Investigación Biosanitaria IBS, Granada, Spain (S.O.P.); Department of Radiology, Radiation Oncology, and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada (C.T.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (C.T.); and Ottawa Hospital Research Institute OHRI and Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada (C.T.)
| | - Carlos Torres
- From the Department of Radiology, MRI Unit, SERCOSA, HT médica, Clínica Las Nieves, Carmelo Torres 2, 23007 Jaén, Spain (E.J.M., T.M.N., A.L.); Department of Ophthalmology, Hospital Virgen de las Nieves, Granada, Spain (S.O.P.); Department of Ophthalmology, Facultad de Medicina, Universidad de Granada, Spain (S.O.P.); Granada Vision and Eye Research Team, Instituto de Investigación Biosanitaria IBS, Granada, Spain (S.O.P.); Department of Radiology, Radiation Oncology, and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada (C.T.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (C.T.); and Ottawa Hospital Research Institute OHRI and Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada (C.T.)
| | - Antonio Luna
- From the Department of Radiology, MRI Unit, SERCOSA, HT médica, Clínica Las Nieves, Carmelo Torres 2, 23007 Jaén, Spain (E.J.M., T.M.N., A.L.); Department of Ophthalmology, Hospital Virgen de las Nieves, Granada, Spain (S.O.P.); Department of Ophthalmology, Facultad de Medicina, Universidad de Granada, Spain (S.O.P.); Granada Vision and Eye Research Team, Instituto de Investigación Biosanitaria IBS, Granada, Spain (S.O.P.); Department of Radiology, Radiation Oncology, and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada (C.T.); Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada (C.T.); and Ottawa Hospital Research Institute OHRI and Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada (C.T.)
| |
Collapse
|
4
|
Patel AJ, Cavuoto KM. Trends in Etiologies, Demographics, and Neuroimaging in New-Onset Adult Strabismus at an Ophthalmic Emergency Department. J Pediatr Ophthalmol Strabismus 2022; 59:269-273. [PMID: 35192377 DOI: 10.3928/01913913-20220201-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate new-onset strabismus in adults presenting to an ophthalmic emergency department, and to identify which patients require neuroimaging. METHODS This was a retrospective review of electronic medical records of patients 18 years and older who presented to an ophthalmic emergency department between January 1, 2019 and December 31, 2020 with new-onset strabismus. Data regarding demographics, causes, neuroimaging, and resolution were recorded and analyzed. RESULTS Of the 557 patients in the current study, 54.8% were men and the mean age was 57.3 ± 16.7 years (range: 18 to 92 years). Most patients (72.4%) presented with diplopia. Esotropia was the most common ocular misalignment (43.6%) and was more common in women than men (51.6% vs 37.0%, respectively) (P = .001). The most common diagnoses were cranial nerve palsies (66.8%) for both sexes and all age groups, with the most common etiology being microvascular (48.1%) for patients 50 years and older and idiopathic (20.1%) for patients between 18 and 49 years old. The incidence of cranial nerve palsies was significantly higher in older patients (P < .001). Neuroimaging was performed in 58% of patients (n = 323), of whom 37.2% (n = 120) had abnormal findings. The most common abnormal neuroimaging finding was mass for all age groups and sexes (19.2%). Patients with cranial nerve palsy and microvascular etiology had a significantly lower proportion of abnormal neuroimaging findings (P < .001). CONCLUSIONS Most cases of new-onset strabismus in adults presenting to the emergency department were due to cranial nerve palsy, particularly in older patients. Despite high rates of neuroimaging, patients with cranial nerve palsy had mostly normal findings. The current study supports the belief that neuroimaging may be deferred in patients older than 50 years with micro-vascular risk factors. [J Pediatr Ophthalmol Strabismus. 2022;59(4):269-273.].
Collapse
|