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This article compares the results of serial multifocal visual evoked potential (mfVEP) recordings with the results of static automated perimetry obtained during a period of 21 months from a patient with a unilateral compressive optic nerve lesion (meningioma). Monocular and interocular mfVEP analyses were performed and compared with normal control subjects. The number of sectors deviating from normal at a significance level of less than .01 in the monocular mfVEP plots appeared to correlate best with the mean deviation of the visual fields. In this patient with compressive optic neuropathy, mfVEP provided additional objective data for evaluating visual function over time.

A 17-year-old woman developed a sixth cranial nerve palsy from a malignant peripheral nerve sheath tumor of the trigeminal nerve. This case is unusual in that the principal symptom was diplopia stemming from a sixth cranial nerve palsy. Pain was mild, and trigeminal function was preserved. Imaging evidence of rapid growth of the cavernous sinus mass gave rise to an initial impression that the cause might be inflammatory. Treatment with gamma knife stereotactic radiosurgery produced some improvement in sixth cranial nerve function and reduction in tumor size over a follow-up period of 9 months.

Prolactinomas are common tumors of the anterior pituitary gland. While conventional therapies, including dopamine agonists, transsphenoidal surgery and radiotherapy, are usually effective in controlling tumor growth, some patients develop treatment-resistant tumors. In this report, we describe a patient with an invasive prolactinoma resistant to conventional therapy that responded to the administration of the alkylating agent, temozolomide.

Charles Bonnet (1720-1792) was an eminent naturalist and philosopher whose contributions to botany and philosophy were highly regarded and honored by his contemporaries in the scientific community of his era in France and England. In1760 he first described and analyzed formed visual hallucinations experienced by his grandfather. The syndrome was named after Bonnet in 1937 by George de Mosier, another native of Geneva, Switzerland.

The term "papilledema" indicates swelling of the optic discs secondary to increased intracranial pressure. Papilledema can be caused by an intracranial mass lesion or by other factors. Visual symptoms frequently accompany papilledema, which can lead to permanent visual loss if left untreated. Starting with an illustrative case, the authors review the pathophysiology of the visual signs and symptoms of papilledema. They also briefly review potential treatment options, focusing on the role of the neurosurgeon in the treatment of patients with papilledema.

Objective: To evaluate the use of multifocal visual evoked potentials in the diagnosis of nonorganic visual field loss., Methods: Five patients with unexplained visual field loss underwent full neuro-ophthalmic examination, Humphrey visual field testing, and multifocal visual evoked potential testing using the Accumap objective perimeter (ObjectiVision Pty Ltd, Sydney, Australia)., Results: In all 5 cases, the results of the ophthalmic examination did not correlate with the degree of visual field loss seen on Humphrey visual field testing. Multifocal visual evoked potentials testing showed essentially normal tracings., Conclusions: Multifocal visual evoked potentials may be useful in cases of difficult to prove functional visual field loss or in cases in which objective documentation of normal function is needed.

Multifocal VEP and mfERG techniques show promise for routine clinical use in neuro-ophthalmology. OCT is now used in many subspecialty areas of ophthalmology, especially in studies of the retina and glaucoma. Although neuro-ophthalmologists must still rely on time-consuming history taking and careful clinical examination, the three modalities described herein can provide objective proof regarding clinical diagnoses in selected cases, saving time and avoiding costly neurologic investigations.

Background and Objective: To describe the changes revealed by multifocal electroretinography (ERG) in patients taking hydroxychloroquine., Patients and Methods: Six patients being treated for various inflammatory conditions with hydroxychloroquine for periods ranging from 8 months to 7 years were consecutively evaluated. Each examination included measurement of Snellen visual acuities, Amsler grid assessment, and automated visual field testing. In some cases, funduscopic examinations were complimented by photography and fluorescein angiography. Multifocal ERG was performed for all patients., Results: Three patients (six eyes) were found to have distinctive abnormalities on multifocal ERG consisting of pericentral depression of ERG signals. The abnormalities on multifocal ERG corresponded with the patients' subjective descriptions and the visual field depiction of their pericentral scotomas. All affected patients had been taking hydroxychloroquine for at least 7 years. One patient with generalized depression on multifocal ERG had possible hydroxychloroquine retinopathy. Two patients (three eyes) had relatively normal results on multifocal ERG., Conclusion: Multifocal ERG objectively demonstrates depression of signals in the perifoveal region in visually symptomatic patients with long-term hydroxychloroquine use. Even patients with normal visual acuity and no fundus abnormalities can have abnormal results. Although we have not yet identified patients with abnormalities on multifocal ERG before the onset of symptoms, multifocal ERG may be useful in monitoring patients at risk and may provide an earlier opportunity to identify maculopathy.

Objective: To determine if patients with nonarteritic ischemic optic neuropathy (NAION) have sleep apnea syndrome (SAS), an entity characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption., Methods: We recruited 17 patients with NAION and 17 age- and sex-matched controls from patients referred for treatment because of suspected restless legs syndrome. We performed overnight polysomnography and determined the respiratory disturbance index during night sleep, a value used to diagnose and grade SAS. We compared the proportions of patients with SAS among patients with NAION and matched controls using the chi(2) test. Additionally, we compared the proportions of patients with SAS among patients with NAION and a large SAS prevalence study using the binomial test., Results: Twelve (71%) of 17 patients with NAION had SAS. According to the respiratory disturbance index, 4 patients (24%) had mild, 4 patients (24%) had moderate, and 4 patients (24%) had severe SAS. Only 3 (18%) of 17 controls had SAS (P =.005). In the 45- to 64-year age group, 4 (50%) of 8 patients with NAION had SAS; 51 (11.9%) of 430 of the random sample in the prevalence study had SAS (P =.005). In the group older than 64 years, 8 (89%) of 9 patients with NAION had SAS; 18 (24%) of 75 of the random sample in the prevalence study had SAS (P<.001)., Conclusions: We found a high prevalence of SAS in patients with NAION, which supports previous case reports suggesting that such an association exists. This association may explain why approximately 75% of all patients with NAION discover visual loss on first awakening or when they first use vision critically after sleeping. Our findings indicate that SAS may play an important role in the pathogenesis of NAION.