Imaging in Neuro-ophthalmology

Neuro-ophthalmology is a clinical discipline, which relies upon a thorough history and comprehensive examination to facilitate diagnostic localization. Advances in magnetic resonance (MR), computed tomography, and functional imaging techniques (e.g., MR spectroscopy and positron emission tomography) have improved our ability to diagnose, treat, and follow neuro-ophthalmic disorders. For example, MRI patterns of brain and spinal cord inflammation are germane to early detection of multiple sclerosis (MS), and help distinguish MS patients presenting with visual complaints from those with other central nervous system inflammatory conditions such as neuromyelitis optica spectrum disorder. Moreover, functional neuroimaging techniques can be used to detect areas of brain hypometabolism indicative of neurodegenerative disorders, when conventional structural MR images fail to correlate with neurological deficits. Noninvasive angiography can detect vascular lesions (e.g., vascular malformations, aneurysms, arterial dissections, and cerebral venous sinus thrombosis) without more invasive conventional catheter imaging (e.g., digital subtraction angiography). Hence, advancing neuroimaging techniques have helped provide timely diagnostic information, while ensuring improved tolerability and safety for patients undergoing neuro-ophthalmic evaluation.