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Showing posts from November, 2022

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Lumbar Puncture

on November 18, 2022

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Fusional Amplitude

on November 14, 2022

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New Diagnosis of Idiopathic Intracranial Hypertension (IIH)

on November 08, 2022

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With this blog I am trying to recreate the conversations I have with my patients in my neuro-ophthalmology practice. If you are not a patient of mine, you are welcome to read, but in that case, I am just another guy putting advice online. Take it for what it is worth...

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Visual Snow

I know there are a lot of internet resources about visual snow syndrome already out there. I guess I just wanted to add my two cents. First of all, the proper name of visual snow syndrome is persistent positive visual phenomena distinct from migraine aura. That is just not a handy name to throw around and PPVPDFMA is not easy on the tongue either. So, although the name is in many ways inadequate most people say "visual snow syndrome" One of the main features of visual snow syndrome is an appearance of snow or TV static in the vision. Patients who have this symptom know exactly what this means. It looks like a texture over everything they see. It usually does not interfere with the true image, but this sensation overlays that image. There is much more, too... Patients with visual snow syndrome often describe floaters, seeing lights when their eyes are closed, experiencing after images and visual trails of moving objects. Some patients even have non-visual symptoms like ring

Vision Symptoms in Parkinson's Disease

Parkinson's patients come to me all the time to evaluate vision symptoms. There are certain complaints that come up frequently. Parkinson's disease is all about slowness of movement. It's not just your walking that slows down, but all kinds of movements, and that does affect the eyes. 1.) The commonest complaint is dry eyes. Your eyelids are there to protect the ocular surface, and every time you blink the eyelid cleans the eye like a little squeegee. Many Parkinson's patients notice that they have reduced facial expressions. Doctors call this "masked facies" (facies means facial expression- doctors do like their special words.) And reduced facial expressions means reduced eyelid blinking. As you read this you will blink plenty- because you are thinking about it. For the remaining 99.9% of the day, blinking is automatic behavior. Have someone look at your blinking when you are not paying any attention and they can give you an idea of how much you blink. Nor

NAION

N on-arteritic A nterior I schemic O ptic N europathy Sometimes people joke that neuro-ophthalmology is the specialty of determining what things aren't. So, first of all, we are not discussing Giant Cell Arteritis, which is why the name of this condition begins with "non-arteritic." Some people say it is like a stroke of the eye. That is a handy shortcut to roughly explain what this disease means, but it is not entirely accurate and I feel like it is important to be clear about what is happening to my patients. First of all, we are not talking about the brain, it is the optic nerve of the eye, so it is not a stroke. A stroke is a brain disease. Second of all, the mechanism is different. Most strokes occur from clots. Maybe a clot forms in the heart or in the neck, then it dislodges and goes up to the brain and does damage. NAION is different because it is due to poor circulation. This image shows the circulation of the eye: The optic nerve is the yellow structure that c

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