Neurology

Neuro-Ophthalmology

Questions discussed in this category

How do you approach new-onset idiopathic intracranial hypertension (IIH) with someone who has history of systemic lupus erythematosus?

Would you consider this to be neuropsychiatric SLE (NPSLE) manifesting as IIH? How do you approach someone with a history of SLE that has been ...

2 Answers available

Is there any benefit from oral vs topical steroids in herpes zoster opthalmicus?

Would the management change if there were complications with optic neuritis?

2 Answers available

How would you approach the upfront management of a patient with acute unilateral vision loss with strong clinical risk factors for both cardioembolic stroke and GCA if an expedited MRI is not possible due to the presence of an AICD?

2 Answers available

What are potential pitfalls in the use of OCT to support a diagnosis of multiple sclerosis?

1 Answer available

What brain imaging findings do you find reliable to help support a diagnosis of idiopathic intracranial hypertension?

1 Answer available

When do you consider tapering tocilizumab in patients with GCA in remission?

4 Answers available

What criteria do you use to decide the duration of IV steroids in patients with optic neuritis?

Is it necessary to do a taper afterward and what would be the recommended tapering schedule/duration?

1 Answer available

How do you determine when to wean patients with idiopathic intracranial hypertension off of acetazolamide?

3 Answers available

When do you use GLP-1 receptor agonists for the management of patients with idiopathic intracranial hypertension (IIH)?

1 Answer available

How do you manage pregnant individuals with newly diagnosed idiopathic intracranial hypertension?

1 Answer available

Do you try to treat the acidosis resulting from acetazolamide in patients with IIH?

1 Answer available

What are the differential and workup for a patient with findings suggestive of idiopathic intracranial hypertension without papilledema on examination?

4 Answers available

How do you utilize Diamox in patients with cerebral venous sinus thrombosis and vision symptoms who do not undergo thrombectomy/recanalization?

3 Answers available

How long do oscillopsia and ataxia secondary to thiamine deficiency last after completing repletion?

1 Answer available

What other conditions should you consider in someone with presumed Tolosa Hunt but without significant improvement on steroid therapy?

2 Answers available

What is your approach to the treatment of idiopathic intracranial hypertension with transverse sinus stenosis?

Do you favor specific medications or surgical interventions?

3 Answers available

Do you ever use ocular ultrasound in evaluation of papilledema?

1 Answer available

What is your approach to immune management in opsoclonus-myoclonus-ataxia syndrome?

1 Answer available

What baseline visual testing, if any, do you recommend at diagnosis for patients with multiple sclerosis who deny visual complaints?

1 Answer available

How does your treatment approach differ in patients with acute visual loss due to central retinal artery occlusion versus retinal vein occlusion?

2 Answers available

What is your approach to the treatment of visual snow syndrome?

1 Answer available

How do you make the decision to empirically treat for GCA when a patient is referred but cannot be immediately seen in clinic?

When a PCP calls with concern for GCA and is wondering whether to start empiric steroids what data do you prioritize to make that decision and do you ...

4 Answers available

How do you use optical coherence tomography in the diagnosis and management of patients with multiple sclerosis and related diseases?

2 Answers available

How would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?

2 Answers available

How do you work up incidentally found papilledema in the emergency room?

2 Answers available

Do you routinely obtain baseline vascular imaging (CTA, MRA, PET) in patients with suspected GCA, but negative temporal artery biopsy?

Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...

2 Answers available

How would you work up and manage an isolated CN3 deficit with anisocoria?

MRI Orbits with possible mild enhancement of unilateral CN3; Brain MRI chronic microvascular disease, mild atrophy.

2 Answers available

What workup do you recommend on patients with suspected ischemic cranial nerve six palsy?

1 Answer available

How do you manage a patient with giant cell arteritis treated with weekly tocilizumab and low dose glucocorticoid who develops sudden vision loss?

2 Answers available

How do you evaluate asymptomatic patients referred for benign intracranial hypertension?

If patients are asymptomatic, what work up do you typically proceed with?

3 Answers available

What is the utility and yield of CSF studies for orbital apex syndrome?

Although probably more familiar to ophthalmologists, orbital apex syndrome refers to the consequence of any kind of swelling or mass effect within the...

1 Answer available

In what conditions can you see roving eye movements?

1 Answer available

Can giant cell arteritis present with a partial cranial neuropathy?

3 Answers available

Would you recommend medical therapy for asymptomatic idiopathic intracranial hypertension with completely normal visual field testing?

2 Answers available

How do you approach the management of patients with one clinical demyelinating event and MOG+ antibody status?

Do you wait for a second clinical event or start immunomodulatory therapy right away?

3 Answers available

How do you approach the management of acute attacks of MOGAD-associated optic neuritis?

Specifically, what do you do if there is minimal improvement with IV steroids and/or IVIG?

2 Answers available

Do you ever attribute oscillopsia to a cortical lesion?

1 Answer available

Do you always perform temporal artery biopsy in patients with positive inflammatory markers and high clinical suspicion of GCA?

2 Answers available

Is either ESR or CRP more sensitive or specific for the diagnosis of GCA?

Additionally, what is the current role for temporal artery ultrasound in workup for GCA?

3 Answers available

In a patient with suspected Miller Fisher syndrome, would you wait until antibody testing results to start IVIG or treat empirically?

Is there is a particular pattern of extraocular motility restriction in Miller Fisher syndrome?

1 Answer available

Which method do you prefer to assess for stigmata of old optic neuropathy?

Ex. optical coherence tomography, visual-evoked potentials

1 Answer available

What is your steroid-sparing agent of choice to treat GCA given the current tocilizumab shortage?

Thoughts on sarilumab vs methotrexate, or just treat with steroids alone

1 Answer available

Papers discussed in this category

Mult Scler Relat Disord, 2020 Dec 16

Interleukin-6 inhibition with tocilizumab for relapsing MOG-IgG associated disorder (MOGAD): A case-series and review.

Neurology(R) neuroimmunology & neuroinflammation, 2017-07

Optical coherence tomography and visual evoked potentials in pediatric MS.

J Med Life,

Optical coherence tomography versus visual evoked potentials in detecting subclinical visual impairment in multiple sclerosis.

J Clin Neurol, 2018 Feb 28

Optical Coherence Tomography versus Visual Evoked Potentials for Detecting Visual Pathway Abnormalities in Patients with Neuromyelitis Optica Spectrum Disorder.

Mult Scler, 2014 Mar 03

Optical coherence tomography and visual evoked potentials: which is more sensitive in multiple sclerosis?

Mult Scler Relat Disord, 2016 Dec 23

Sensitivity of visual evoked potentials and spectral domain optical coherence tomography in early relapsing remitting multiple sclerosis.

N Engl J Med,

Trial of Tocilizumab in Giant-Cell Arteritis.

Lancet, 2016 Mar 04

Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial.

Arthritis Rheum,

Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis.

Seminars in arthritis and rheumatism, 2012-06

Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis.

Arthritis Rheumatol, 2021 Jul 08

2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis.

Ann Rheum Dis, 2019 Jul 03

2018 Update of the EULAR recommendations for the management of large vessel vasculitis.

Mayo Clin Proc,

My Treatment Approach to Giant Cell Arteritis.

Arch Neurol,

Contemp Neurol Ser,

The diagnosis of stupor and coma.

Arthritis Res Ther, 2021 Mar 22

Vision loss in patients with giant cell arteritis treated with tocilizumab.

Arthritis Care Res (Hoboken), 2020 May 19

Prevalence of Giant Cell Arteritis Relapse in Patients Treated With Glucocorticoids: A Meta-Analysis.

J Rheumatol, 2021 Feb 15

Real-world Risk of Relapse of Giant Cell Arteritis Treated With Tocilizumab: A Retrospective Analysis of 43 Patients.

Rheumatology (Oxford),

Risk of relapse after discontinuation of tocilizumab therapy in giant cell arteritis.

JAMA Neurol,

The Dilemma of Diagnosing Idiopathic Intracranial Hypertension Without Papilledema in Patients With Chronic Migraine.

JAMA Neurol,

Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema.

Archives of ophthalmology (Chicago, Ill. : 1960), 2010-06

Diagnosis and grading of papilledema in patients with raised intracranial pressure using optical coherence tomography vs clinical expert assessment using a clinical staging scale.

European journal of neurology, 2013 Mar 29

Safety of lumbar puncture in patients with cerebral venous thrombosis.

Rheumatology (Oxford, England), 2015-03

Large-vessel giant cell arteritis: a cohort study.

Archives of ophthalmology (Chicago, Ill. : 1960), 2008 Jul

Treatment of acute optic neuritis: a summary of findings from the optic neuritis treatment trial.

Open access rheumatology : research and reviews, 2016

Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment.

Medicine, 2016 Feb

Description and Validation of Histological Patterns and Proposal of a Dynamic Model of Inflammatory Infiltration in Giant-cell Arteritis.

Histopathology, 2023 Aug 08

Age-related histopathological findings in temporal arteries.

Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology, 2023 Sep 06

Consensus statement on the processing, interpretation and reporting of temporal artery biopsy for arteritis.

BMC musculoskeletal disorders, 2016-08-24

The effect of clinical features and glucocorticoids on biopsy findings in giant cell arteritis.

Neurology(R) neuroimmunology & neuroinflammation, 2022 Mar 08

Diagnosis and Management of Opsoclonus-Myoclonus-Ataxia Syndrome in Children: An International Perspective.

Arthritis Rheum,

The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes.

Cureus, 2024 Aug 19

Transverse Sinus Stenosis as an Underdiagnosed Cause of Chronic Headache: A Case Report.

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society, 2015 Dec

Brain Imaging in Idiopathic Intracranial Hypertension.

Neurology, 2013 Aug 21

Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children.

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