Neuro-vascular Neuro-ophthalmology

Neuro-ophthalmological symptoms frequently arise indisorders which alter the intracranial and intraorbitalcirculation. Because of the wide range of sensory andcognitive systems involved in vision and eye movements,visual disturbances are typically found in the commonvascular disorders, such as atherosclerosis, migraine, andaneurysms, but can also result from practically any, commonor rare,local or systemic vascular disorder. Thedysfunction can be part of a largersyndrome or thepredominant clinical abnormality. Many of the newer conceptsconcerning the diagnosis and treatment of neurovasculardisorders have evolved in consequence of advances intechniques for neuroimaging such as MRI; methods ofmeasuring systemic coagulation and inflammation; andsuperselective catheterization ofabnormal blood vessels andvascular lesions. The neuroophthalmological evaluation ofclinical signs and symptoms often leads to accuratelocalization and diagnosis of the lesion. Many of theseclinical abnormalities, such as visual field defects andocular misalignments, can be quantified and followed toassess either the natural history of the disorder or theeffects of therapies. No one medical specialty can manage these neurovascularneuro-ophthalmological disorders alone. The complexity ofdiagnosis and treatment planning requires a multi-disciplinary team. This approach, bringing ophthalmologists,neurosurgeons, and neurologists together to confer in themanagement of these cases, has been pioneered by theauthors' group at the New York University Medical Center.