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The optic nerves, which constitute the axonic projections of the retinal ganglion cells to the lateral geniculate bodies and superior colliculi (the third visual neurons), can be inspected in the optic nerve head Observable changes in the optic disc are therefore of particular importance They may re ect the presence of raised intracranial pressure (papilledema or choked disc ), as already described; optic neuritis ( papillitis ); infarction of the optic nerve head; congenital defects of the optic nerves (optic pits and colobomas); hypoplasia and atrophy of the optic nerves; and glaucoma Illustrations of these and other abnormalities of the disc and ocular fundus can be found in the atlas by E M Chester and in the text by Glaser, listed in the References The main causes of visual loss from optic neuropathy are listed in Table 13-2 and discussed in the following portions of this chapter Optic Neuritis (Papillitis; Retrobulbar Neuritis) (See also page 777) Acute impairment of vision in one or both eyes (the eyes being affected either simultaneously or successively) develops in a number of clinical settings, particularly with multiple sclerosis The most frequent situation is one in which an adolescent or young adult (rarely a child) notes a rapid diminution of vision in one eye (as though a veil had covered the eye), sometimes progressing within hours or days to complete blindness The optic disc and retina may appear normal (retrobulbar neuritis), but if the in ammation is near the nerve head, there is swelling of the disc, ie, papillitis (Fig 13-11); the disc margins are then seen to be elevated, blurred, and, rarely, surrounded by hemorrhages As indicated above, papillitis is associated with marked impairment of vision and a scotoma, thus distinguishing it from the papilledema of increased intracranial pressure Pain on movement and tenderness on pressure of the globe and a difference between the two eyes in the perception of brightness of light are other fairly consistent ndings (Table 13-1) The pupil on the affected side may have a muted response to direct light The patient may report an increase in blurring of vision with exertion or following a hot bath (Uthoff phenomenon) If there is papillitis, examination may disclose variable haziness of the vitreous that causes dif culty in visualizing the retina In ammatory sheathing of the retinal veins, as described by Rucker, is known to occur but has been an uncommon nding in our patients In extreme cases, edema may suffuse from the disc to cause a rippling in the adjacent retina However, as just noted, most cases of optic neuritis are retrobulbar and little is to be seen when examing the optic nerve head In about 10 percent of cases, both eyes are involved, either simultaneously or in rapid succession In a proportion of such patients no cause of the optic neuropathy can be found, but a rst bout of multiple sclerosis is always suspected, as discussed in Chap 36 After several weeks there is spontaneous recovery; vision returns to normal in more than twothirds of instances Regression of symptoms may occur spontaneously or may be hastened by the intravenous administration of high doses of corticosteroids, but in one study the oral administration of the same drugs increased the frequency of a relapse of optic neuritis (page 788) Occasionally, diminution of brightness, dyschroma-. print barcode labels in excel 2010 How to derive the CHECK DIGIT of EAN Codes? - MrExcel.com
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Apr 10, 2018 · This video shows how to create barcode in Excel 2016. How to link barcode data to the Excel ...Duration: 3:32 Posted: Apr 10, 2018 Optic neuritisa ( papillitis ) Hyaline bodiesb (drusen) Infarction of disc and intraorbital optic nerve due to atherosclerosis or temporal arteritis In ammatory changes in disc and intraorbital part of optic nerve usually due to MS, sometimes to ADEM Congenital, familial 5 4 6 1 None or transient blurring; constriction of visual elds and enlargement of blind spot; ndings almost always binocular Acute visual loss, monocular (usually); may be an altitudinal defect Rapidly progressive visual loss; usually monocular | 79 Key: MS, multiple sclerosis; ADEM, acute disseminated encephalomyelopathy a Optic neuritis affecting the retrobulbar portion of the nerve shows no funduscopic changes b May be mistaken for papilledema (pseudopapilledema) topsia, or a scotoma is left; rarely, the patient is left blind The optic disc later becomes slightly pale, especially on the temporal side, and the pallor extends beyond the margins of the disc into the peripapillary retinal nerve ber layer The CSF may be normal or may contain from 10 to 100 lymphocytes, an elevated total protein and gamma globulin, and oligoclonal bands As time progresses, approximately half of such patients will develop other symptoms and signs of multiple sclerosis, usually within 5 years, and probably even more do so when they are observed for longer periods In approximately 15 percent of patients with multiple sclerosis, the history discloses that retrobulbar neuritis was the rst symptom Postinfectious demyelinative disease is a probable cause in the minority of cases that do not later show signs of multiple sclerosis Less is known about children with retrobulbar neuropathy, in whom the disorder is more often bilateral and frequently related to a preceding viral infection ( neuroretinitis, see below) Their prognosis is better than that of adults Formerly, optic neuritis was often blamed on paranasal sinus disease, but this rarely affects vision and this diagnosis should be accepted only in the face of other evidence of infection, such as fever, purulent nasal discharge, leukocytosis, etc; even then, the association is tenuous, as discussed further on Despite the return of visual acuity in the majority of patients, a degree of optic atrophy almost always follows an attack of optic neuritis The disc then appears shrunken and pale, particularly in its temporal half (temporal pallor) The pattern-shift visual evoked potential becomes delayed as a result; this test is also a useful indicator of previous, even asymptomatic, episodes of optic neuritis The treatment of optic neuritis is taken up with multiple sclerosis in Chap 36 . Leber hereditary optic atrophy may simulate retrobulbar neuropathy, even at times in causing a relatively abrupt onset of visual loss and some degree of recovery (page 949) Certain nutritional and toxic states may do the same, as well as sarcoidosis and the other causes of optic neuropathy discussed further on In neuroretinitis, which is related to optic neuritis, papillitis Figure 13-11 Acute optic neuritis in a patient with multiple sclerosis The disc is swollen from an in ammatory process near the nerve head (papillitis) and the patient is virtually blind in the affected eye . how do i print barcodes in excel 2010 Barcodes in Excel 2007 spreadsheets - ActiveBarcode
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