Ultrasound in Neuro-Ophthalmology

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Identifier Ultrasound_in_Neuro-Ophthalmology
Title Ultrasound in Neuro-Ophthalmology
Subject Ultrasound, Neuro-ophthalmology, Imaging
Creator Andrew G. Lee, MD, Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, TX; Professor of Ophthalmology, Weill Cornell Medicine; Jaijo Jaison Vennatt, Baylor College of Medicine Class of 2021
Description Dr. Lee lectures medical students on ultrasound in neuro-ophthalmology.
Transcript So today we are just going to talk about how we use ultrasound. Not all ultrasound, just ultrasound for neuro-op. So, ultrasound has a lot of utility in terms of intraocular tumors and looking for orbital disease. But in neuro-op, we really are using ultrasound in very defined ways. The first is when we are looking at the optic nerve head, if we see drusen; ultrasound is a very good way of detecting calcified drusen. So if we have a patient with pseudo-papilledema, the ultrasound will show the hyperechoic calcium inside the disc head itself and in addition to looking for drusen, we can look for fluid in the optic nerve sheet and the fluid in the optic nerve sheath can be squeezed out of the eye by moving the eye. So normally, the optic nerve is like a little bit S-shaped, like this, and so when we go from the primary position to extremes of gaze, it kind of pushes the fluid in the sheath out of the sheath and so we can measure the diameter of the optic nerve sheath-nerve complex in primary and 30 degrees off of primary and that 30 degree test can tell us if the fluid is in the sheath. And so, we have ultrasound for looking for calcified drusen and for looking for fluid in the sheath which is pseudo-papilledema versus true papilledema. The other way that we have been using the ultrasound is for the temporal artery. So, in the temporal artery, we would normally do a temporary biopsy and what we are looking for in the temporal artery biopsy is the internal elastic lamina is disrupted and that leads to inflammation, lymphocytic infiltration, thickening of the wall, and the narrowing of the lumen. And because there is white cells and a multinucleated giant cell, pathology specimens of the temporal artery can show active temporal arteritis. But ultrasound is also able to see the same things. The ultrasound can see the narrowing of the lumen and the ultrasound can see the ultrasonographic equivalent of the lymphocytic infiltrate because we can see a halo and that halo sign is what we are looking for in giant cell arteritis. When we are doing ultrasounds of the temporal artery, we are looking for that halo of hyperintense hyperechoic against hypoechoic white cells inside the lumen of the vessel and the narrowing of the lumen. So, the halo sign can be used for temporal arteritis. And then finally, we can use it for looking at the muscles. So when we are looking at the muscles, we are looking for myositis, and because the resolution of ultrasound is better than CAT scan, it can show us thickening of the muscles and the most common cause of big muscles, as you know in adults, is thyroid eye disease. But if it is just one muscle, or if it is eye pain, or it is only one side, then we are looking for myositis. So, enlargement of the muscles can be seen on ultrasound of the orbit. Ultrasound is a really great way of looking at the eye and the orbit because it is very close to the surface. And we are using soundwaves instead of x-rays or light to make the signal. In neuro-op, our most prominent indications are pseudo-papilledema from calcified drusen, fluid in the sheath to look for evidence of increased intracranial pressure radiographically or ultrasonography, and the halo sign in giant cell arteritis, as well as myositis.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2020. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6b61ztd
Setname ehsl_novel_lee
Date Created 2020-05-27
Date Modified 2020-05-27
ID 1561536
Reference URL https://collections.lib.utah.edu/ark:/87278/s6b61ztd