Neuro-ophthalmologic urgencies and emergencies

Several key neurological emergencies present with ocular signs and symptoms. It is therefore imperative that these neuro-ophthalmologic emergencies are not missed. This review discusses the most important clinical findings, relevant exam maneuvers, and treatment strategies for these neuro-ophthalmic emergencies. The disorders are separated into their main presenting symptom to help guide the approach to patients with acute onset vision loss, optic disc edema, anisocoria, and diplopia. In the acute vision loss section, we discuss giant cell arteritis, retinal artery occlusions, pituitary apoplexy, mucormycosis, and toxic optic neuropathies. In the following section on papilledema, intracranial hypertension, hypertensive optic neuropathy and retinopathy, and non-emergent differentials are reviewed. For anisocoria, we discuss the significance of diagnosing Horner syndrome and its association with carotid dissection and brainstem strokes and provide a discussion on differential diagnoses. Finally, we review diplopia and disorders of ocular motility-including the such dangerous possibilities as aneurysmal third cranial nerve palsy, carotid sinus thrombosis, acute brainstem pathology, botulism, and Wernicke encephalopathy. Keeping these essential diagnoses in mind while approaching patients with acute neuro-ophthalmologic complaints can save not only vision but also lives.