Untersuchungen des visuellen Systems in der Neurologie: aktuelle Forschung und klinische Relevanz

Zusammenfassung

Die orientierende Darstellung des afferenten visuellen Systems ist integraler Bestandteil der neurologischen Anamnese und der klinisch neurologischen Untersuchung. Durch die anatomische Zugehörigkeit zum zentralen Nervensystem, das Auftreten von Sehverlust bei vielen neurologischen Erkrankungen, und durch die erhebliche Bedeutung eines Sehverlustes für die Lebensqualität von Betroffenen erfährt die Untersuchung des afferenten visuellen Systems durch moderne diagnostische Verfahren zunehmende Bedeutung. Niedrigkontrast-Sehen oder Farbsehtests können klassische Visustests ergänzen. Mithilfe von multifokal visuell evozierten Potenzialen können einzelne Stränge der Sehbahn untersucht werden. Optische Kohärenztomografie erlaubt die hochaufgelöste Darstellung der Netzhaut mit ihren einzelnen Schichten. Diffusionsbildgebung und funktionelle Magnetresonanztomografie erlauben in der Forschung die mikrostrukturelle und funktionelle Untersuchung des visuellen Systems. Strukturierte Fragebögen können für das Screening auf Sehstörungen genutzt werden. Eine detaillierte Untersuchung des afferenten visuellen Systems gehört zunehmend zur erweiterten neurologischen Untersuchung bei neuroimmunologischen Erkrankungen wie Multiple Sklerose, Neuromyelitis optica, MOG-IgG assoziierter Enzephalomyelitis oder Susac-Syndrom, aber auch beim Parkinson Syndrom oder anderen neurodegenerativen Erkrankungen. Dieser Übersichtsartikel skizziert die Prinzipien der wichtigsten Methoden zur strukturellen und funktionellen Untersuchung des visuellen Systems und fasst exemplarisch die Ergebnisse der Anwendung dieser Methoden bei relevanten neurologischen Erkrankungen zusammen.

Abstract

A preliminary assessment of the afferent visual system is part of neurological history taking and the neurological examination. The afferent visual system including the retina is part of the central nervous system. Many neurological diseases can cause loss of visual function, which is an important determinant of loss of quality of life in affected patients. This has led to an increasing application of state-of-the-art diagnostic methods for investigating the afferent visual system in clinical neurology and neurological research. Low-contrast visual acuity tests and color vision tests can complement classic high-contrast visual testing. Multifocal visual evoked potentials allow assessment of axonal strands. Optical coherence tomography enables high-resolution imaging of the retina and intra-retinal layers. In clinical research, diffusion weighted imaging and functional magnetic resonance imaging can be used for microstructural and functional assessment of neuronal structures and white matter. Structured questionnaires are available to screen for visual function loss. A detailed assessment of the afferent visual system is increasingly part of neurological examinations not only in autoimmune neuroinflammatory disorders like multiple sclerosis, neuromyelitis optica, MOG-IgG associated encephalomyelitis or Susac syndrome, but also in Parkinson’s disease and other neurodegenerative disorders. This review outlines relevant methods for structural and functional assessment of the afferent visual system and summarizes showcases for application of these methods in neurological diseases.

Schlüsselwörter

visuelles System - optische Kohärenztomografie - Sehstörungen - Diffusions-gewichtete Bildgebung - VEP

Keywords

visual system - optical coherence tomography - visual dysfunction - diffusion tensor imaging - visual evoked potentials

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