Neuro-ophthalmological syndromes for neurologists.

Correspondence to: Dr David Perkin, Division of Neuroscience and Psychological Medicine, Imperial College London, Charing Cross Campus, St Dunstan’s Road, London W6 8RP, UK; d.perkin@imperial. ac.uk _________________________ T he conditions or syndromes to be considered in this article are summarised in table 1. Many are seen relatively infrequently in neurological practice. Among 4000 successive outpatient referrals, pupillary abnormalities or ophthalmological syndromes accounted for 39 (table 2). More often, some of these abnormalities—for example, a tonic pupil (Holmes-Adie syndrome)— are found by chance. Sometimes the abnormality has not been previously recognised or, even worse, has been misinterpreted. Documentation of such changes is important—not necessarily towards diagnosing the patient’s complaint, but towards preventing misinterpretation of the problem in the future. In the acutely ill patient, the recognition of the syndromes of brain herniation, particularly uncal and trans-tentorial, are critical to patient care.