Article
The benefit of hindsight: analysing missed neuro-ophthalmic diagnoses
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Authors
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G.G.W. Adams
- Consultant Ophthalmic Surgeon, Strabismus and Paediatric Service, Moorfields Eye Hospital, London, UK
| Published: | September 22, 2004 |
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Outline
Text
The incidence of brain tumours is stated to be increasing but clinical outcome for the most aggressive and commonest tumours has not improved. Modern imaging with CT and MRI has made it easier to diagnose tumours earlier and more easily than in the past. The presenting signs will depend on the site of the tumour and its growth. Earlier diagnosis of some tumours can reduce morbidity. Late diagnosis may not only cause a poorer outcome but can lead to litigation.
Some patients with brain tumours will present initially to the ophthalmologist with visual symptoms; brain tumours are easy to diagnose if they present with papilloedema from raised intracranial pressure. Much more difficult to diagnose is the patient who does not have papilloedema but who presents with other signs and symptoms. How does an ophthalmologist avoid missing such cases?
Three cases will be presented to illustrate different modes of presentation of patients with a brain tumour, and the problems in diagnosis, in the hope that this will help participants to avoid mis-diagnosing such cases.
