Vision Changes: Neurological Pathology

Pathology	Picture/Description	Onset	U/L or B/L	Etiology	Other Sx
[Optic] Nerve Disease
Optic Neuritis - Retrobulbar Optic Neuritis - Papillitis: swelling of the optic disk inflammation of the eyelid	Optic disk appears hyperemic/swollen		Usually U/L	Usually idiopathic, but can be assoc'd w/ M.S.	Reduced visual acuity, relative afferent pupillary defect..
- Papilledema: a type of papillitis from increased intracranial pressure (ICP)			B/L	Fragmentation of elastica with surrounding inflammation surrounding the vessel	Acuity/reflexes are usually normal

Pathology	Picture/ Description	Onset	U/L or B/L	Etiology	Other Sx	Dx
Ischemic Optic Neuropathy	Pale, swollen disk		.		Loss of acuity and visual field
Giant-Cell Arteritis	.	.	.	.	Pathognomonic: jaw claudication s (pain w/ chewing) Also: malaise, limb girdle pain, scalp tenderness/pain when combing hair	ESR is good screen can see markedly elevated
Trauma	.	.	.	Concussive head trauma sheers the vascular supply

Visual Pathway Disorders
Hemianopia	Vision loss in 1/2 of the visual field: bitemporal: keep nasal, lose temporal fields homonymous: lose either left or right sides of visual fields	Gradual or sudden	B/L	Vascular event (eg, post. cerebral artery, middle cerebral artery) or tumor causing ischemia in occipital lobe.	MRI or CT to identify source
Cortical Blindness	Normal fundus and pupillary reflex with complete loss of vision

Nerve/Optic Nerve Pathology