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CHAPTER OUTLINE

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  • INTRODUTION

  • CHIEF COMPLAINT AND HISTORY OF PRESENT ILLNESS

    • Visual loss

    • Positive visual and hallucinations

    • Diplopia

    • Ptosis Anisocoria

    • Pain and Photophobia

  • REVIEW OF SYSTEMS AND OTHER HISTORY

  • EXAMINATION OVERVIEW

    • Function

    • Structure

    • Putting it all together

  • EXAMINING THE EYE AND ORBIT

  • CLINICAL ANCILLARY TESTS

    • Photography

    • Intravenous fluorescein angiography

    • Optical coherence tomography

    • Ultrasonography

  • NEUROIMAGING

    • Computed tomography

    • Magnetic resonance imaging

    • Imaging the orbit

    • Imaging the brain

    • Cerebral angiography

    • Functional neuroimaging

  • KEY POINTS

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INTRODUCTION

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The art and science of obtaining a meaningful history is the keystone of neuroophthalmology. Some may doubt the importance of the history in ophthalmology—because the examiner has the unique ability to actually see the organ of interest inside and out in vivo (unlike the cardiologist or nephrologist)—but a single day in a busy neuroophthalmology clinic will put that notion to rest.

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We do not wish to imply that neuro-ophthalmic history-taking should be a lengthy, memorized barrage of questions relating to every system in the body. Instead, the effective examiner is similar to a mechanic with a large chest of tools, carefully selecting the correct instruments for the task at hand. Because effective history-taking depends on a thorough knowledge of the many manifestations of disease in the visual system, it is truly the most complex “procedure” a physician can perform on a patient. A guide, outlining the components of the neuro-ophthalmic history, is provided in Table 1–1.

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Table Graphic Jump Location
TABLE 1–1.

ELEMENTS AND RATIONALE OF THE HISTORY

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CHIEF COMPLAINT AND HISTORY OF PRESENT ILLNESS

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Neuro-ophthalmic chief complaints usually concern visual loss, positive visual phenomena, diplopia, ptosis, anisocoria, pain, and photophobia. Vision complaints are often difficult for patients to articulate. In addition, neuro-ophthalmic patients commonly present with an array of seemingly disjointed complaints, offering a considerable challenge to even to the most determined historian. For this reason, crystallizing the patient's concerns into a list of individual complaints, prioritized ...

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