A Narrative Review on Neuro-Ophthalmological Manifestations That May Occur during Pregnancy

AIM

As a medical condition, pregnancy mandates the simultaneous treatment of both the mother and the fetus, making it a distinctive aspect of clinical medicine.

MATERIAL AND METHOD

We analyze the physiological changes occurring in the eyes and brain during pregnancy, as well as the neuro-ophthalmological manifestations that can occur during pregnancy. Studies published in both English and other languages, case reports, and reviews from 2011 to 2023 onwards were included. All surveys were acquired by exploring the databases.

RESULTS

We found a total of 2135 articles that showcase neuro-ophthalmic changes related to pregnancy: review and research articles (Science Direct 804, Web of Science 923, Scopus 345, and 63 Pub Med). In total, 86 studies were examined after applying the inclusion and exclusion criteria. Bilateral papilledema can be a warning sign for intracranial hypertension or cerebral venous sinus thrombosis. Additionally, when unilateral, it is important to differentially diagnose anterior ischemic optic neuropathy secondary to a hypercoagulant, compressive or inflammatory optic neuropathy, optic neuritis, or even orbital pseudotumor state. Severe eclampsia and preeclampsia can manifest as choroidal infarction, serous retinal detachment, and even cortical blindness. There can also be implications at the level of cranial nerves or transient Horner syndrome.

CONCLUSIONS

Evaluating and treating a pregnant woman with neuro-ophthalmological manifestations is challenging. The obstetrician closely follows and has a medical relationship with the pregnant woman; hence he/she might be the first to be informed about the general condition of the pregnant woman or might request an ophthalmologic examination tailored to each specific case.

The Birthday Party Test (BPT): A new picture description test to support the assessment of simultanagnosia in patients with acquired brain injury

There is broad consensus on the utility of complex pictures in the assessment of simultanagnosia in patients with acquired brain injury (ABI). To overcome various shortcomings of current instruments, we have developed the Birthday Party Test (BPT); a picture description test that contains a neutral scene, a balanced representation of events, and provides clear instructions and a scoring-aid. We have applied the BPT in a large group of patients with ABI (n = 502) and in an age-matched healthy control group (n = 194). Our results show that performance on the BPT was associated with a range of descriptive, neuropsychological and clinical characteristics and that poor test performance appeared to be more common in patients with etiologies that have an increased risk of bilateral damage. Furthermore, we assume a high correspondence between test performance on the BPT and the assessor's clinical judgment of likely having simultanagnosia in preliminary analyses. This study shows the potential usefulness of the BPT to support diagnostic decision making in simultanagnosia. The BPT is made freely available to facilitate its broad application in the clinical assessment of patients with visual impairment and to enable a further evaluation of its utility and validity in future studies.

Neuro-ophthalmic disorders in pregnancy

PURPOSE OF REVIEW

This review discusses evaluation and treatment of neuro-ophthalmic disorders in the pregnant patient.

RECENT FINDINGS

Any neuro-ophthalmic abnormality seen in nonpregnant women can be seen in pregnant women. Pregnancy-specific complications (preeclampsia and eclampsia) cause visual symptoms and can affect the entire visual axis.

SUMMARY

Appropriate evaluation and examination is important to preserve the health and vision of the mother and prevent complications in the fetus. Evaluation should proceed in the same way for a pregnant patient as it would for a nonpregnant patient, with few exceptions. Treatment decisions may be influenced by stage of pregnancy.