Protocolo diagnóstico-terapéutico del paciente con pérdida aguda de visión

  1. Alberte Woodward, M. 1
  2. Abalo Lojo, J.M. 2
  3. Prieto González, J.M.Ó. 1
  1. 1 Servicios de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
  2. 2 Servicios de Oftalmología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
Journal:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Year of publication: 2023

Issue Title: Enfermedades del sistema nervioso (IX): Enfermedades desmielinizantes

Series: 13

Issue: 78

Pages: 4655-4659

Type: Article

DIALNET GOOGLE SCHOLAR

More publications in: Medicine: Programa de Formación Médica Continuada Acreditado

Abstract

Recent vision loss is a common complaint, more often unilateral than bilateral. The temporal pattern of onset may be classified into transient, hyperacute, acute, and subacute-chronic losses, and the presence or absence of pain is also a relevant criterion. Among transient losses, amaurosis fugax is worth highlighting because it may herald an established ischemic stroke. Among hyperacute losses, urgent diagnosis of central retinal artery occlusion is imperative, given the possibility of reperfusion treatment with alteplase (off-label) in the first 4.5 hours. In acute forms, the presence or absence of papillitis distinguishes between anterior and posterior (or retrobulbar) optic neuropathies, the latter being typical of demyelinating processes. In either transient, hyperacute and acute forms, and especially in the context of pain, identification of an arteritic process is mandatory as it would dictate the urgent initiation of corticosteroid therapy.

Bibliographic References

  • Hickman SJ. Neuro-ophthalmology. Pract Neurol. 2011;11(3):191-200.
  • Mac Grory B, Schrag M, Biousse V, Furie KL, Gerhard Herman M, Lavin PJ. Management of central retinal artery occlusion: A scientific statement from the American Heart Association. Stroke. 2021;52(6):e282-94.
  • Dimberg EL. Rheumatology and neurology. Continuum (Minneap Minn). 2017;23(3, Neurology of Systemic Disease):691-721.
  • Repovic P. Management of multiple sclerosis relapses. Continuum (Minneap Minn). 2019;25(3):655-69.
  • Van Stavern GP. Metabolic, hereditary, traumatic, and neoplastic optic neuropathies. Continuum (Minneap Minn). 2014;20(4):877-906.
  • Gerstenblith AT, Rabinowitz MP, editors. Manual de oftalmología del Wills Eye Institute: diagnóstico y tratamiento de la enfermedad ocular en la consulta y en urgencias. 8a ed. Barcelona: Wolters Kluwer Health; Lippincott Williams & Wilkins; 2022.
  • Biousse V, Newman N. Retinal and optic nerve ischemia. Continuum (Minneap Minn). 2014;20(4 Neuro-ophthalmology):838-56.
  • Costello F. Inflammatory optic neuropathies. Continuum (Minneap Minn). 2014;20(4 Neuro-ophthalmology):816-37
Data source: Dialnet