Neuro-vascular Neuro-ophthalmology

Neuro-ophthalmological symptoms frequently arise in disorders which alter the intracranial and intraorbital circulation. Because of the wide range of sensory and cognitive systems involved in vision and eye movements, visual disturbances are typically found in the common vascular disorders, such as atherosclerosis, migraine, and aneurysms, but can also result from practically any, common or rare, local or systemic vascular disorder. The dysfunction can be part of a largersyndrome or the predominant clinical abnormality. Many of the newer concepts concerning the diagnosis and treatment of neurovascular disorders have evolved in consequence of advances in techniques for neuroimaging such as MRI; methods of measuring systemic coagulation and inflammation; and superselective catheterization ofabnormal blood vessels and vascular lesions. The neuroophthalmological evaluation of clinical signs and symptoms often leads to accurate localization and diagnosis of the lesion. Many of these clinical abnormalities, such as visual field defects and ocular misalignments, can be quantified and followed to assess either the natural history of the disorder or the effects of therapies. No one medical specialty can manage these neurovascular neuro-ophthalmological disorders alone. The complexity of diagnosis and treatment planning requires a multi- disciplinary team. This approach, bringing ophthalmologists, neurosurgeons, and neurologists together to confer in the management of these cases, has been pioneered by the authors' group at the New York University Medical Center.