Diagnostic imaging in neuro-ophthalmology | Radiología (English Edition)

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Corte axial con ventana ósea (a) y reformateo sagital con algoritmo de partes blandas (b y c) en una mujer de 26 años con traumatismo facial tras un accidente de tráfico. Presentó múltiples fracturas del seno maxilar y de la órbita izquierdos, con fractura multifragmentada del techo orbitario, objetivando un fragmento (flecha) en el agujero óptico, lo que produjo una lesión irreversible del nervio óptico a pesar del tratamiento urgente. Traumatismo orbitario. Cortes axial (d) y reformateo sagital (e) de TC realizada a una anciana de 80 años tras una caída por las escaleras, con hematoma periorbitario y limitación de la motilidad ocular. Engrosamiento y desflecamiento de la grasa retrobulbar y perineural compatible con hematoma, que fue drenado con carácter urgente." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.C. Vela Marín, P. Seral Moral, C. Bernal Lafuente, B. Izquierdo Hernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.C." 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CTC in one patient with cervical carcinoma treated with radiation therapy after incomplete optical colonoscopy due to impassable stenosis. (a) CT image reconstruction in the coronal plane that reveals protrusions (arrows) and stenoses (not shown). (b) The 3D image shows one of the polypoid lesions that looks ulcerative in the optical colonoscopy (c)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Martínez-Sapiña Llanas, S.A. Otero Muinelo, C. Crespo García" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Martínez-Sapiña Llanas" ] 1 => array:2 [ "nombre" => "S.A." "apellidos" => "Otero Muinelo" ] 2 => array:2 [ "nombre" => "C." 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(b) Ten (10) different measurements taken in the region of interest expressed as average kPa and m/s, and an IQR below 0.30." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Murad Gutiérrez, J.A. Romero Enciso" "autores" => array:2 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Murad Gutiérrez" ] 1 => array:2 [ "nombre" => "J.A." 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Vela Marín, P. Seral Moral, C. Bernal Lafuente, B. Izquierdo Hernández" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A.C." "apellidos" => "Vela Marín" "email" => array:1 [ 0 => "acvela@salud.aragon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Seral Moral" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Bernal Lafuente" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Izquierdo Hernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico por la imagen en neuroftalmología" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1894 "Ancho" => 2500 "Tamanyo" => 335579 ] ] "descripcion" => array:1 [ "en" => "Orbital trauma. Axial slice with bone window (a) and sagittal reformatting with soft tissue algorithm (b and c) in a 26-year-old woman with facial trauma after a recent traffic accident. She had multiple fractures in her left maxillary sinus and orbit, with multi-fragmented fracture in her orbital roof, revealing one fragment (arrow) in the optic foramen that caused an irreversible lesion of the optic nerve despite urgent treatment. Orbital trauma. Axial slice (d) and sagittal reformatting (e) of CT scan performed on an 80-year-old woman after falling down the stairs, with periorbital hematoma and limitation of ocular motility. Thickening and fraying of retrobulbar and perineural fat compatible with hematoma, which was immediately drained." ] ] ] "textoCompleto" => "IntroductionThe pathology of optic pathways and the orbital structures varies widely, but it has little global incidence, therefore its study and assessment represent a small volume of cases in a radiologist's standard practice, making it a not very well-known condition and, at times, difficult to manage. That is why it is useful to review the anatomy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), expose which are the imaging modalities suitable for its evaluation and make the right differential diagnosis based on the symptoms.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Visual pathwaysThere are photoreceptors, cones and rods in the retina in charge of making the synapses with the first neurons or bipolar cells, and in turn these make second synapses with ganglion cells, whose axons make up the optic nerve fibers.<a class="elsevierStyleCrossRef" href="#bib0325">1</a> The nasal hemiretina receives information from the temporal visual field, and the temporal information is received from the nasal visual field. There also occurs a superior–inferior crossing, so that the information from the superior visual field is collected by the inferior hemiretinas, and vice versa.<a class="elsevierStyleCrossRefs" href="#bib0325">1,2</a> The optical nerve runs through the orbit and into the skull via the optic foramen. It is surrounded by meningeal layers in continuity with the intracranial meninges and by cerebrospinal fluid.The intracranial segments of both optic nerves converge forming the optic chiasm. The temporal fibers of each retina (nasal visual fields) remain on the same side (homolateral), and the medial ones (temporal visual fields) decussate toward the contralateral side. Only one half the macular fibers decussate; the rest remain on the homonymous side.<a class="elsevierStyleCrossRefs" href="#bib0325">1,3</a>The optic tracts start from the chiasm and, surrounding the mesencephalon, reach the lateral geniculate body, the thalamic nucleus located behind the pulvinar nucleus.The geniculo-calcarine tracts (optic radiations) connect the lateral geniculate nuclei with the visual cortex. The superior axons relay information from the inferior visual fields, run lateral to the atrium and the posterior horn of the lateral ventricle, pass through the parietal white matter and reach the occipital cortex on the calcarine sulcus. Inferior fibers, with information from the superior visual fields, curve antero-laterally, pass through the caudal portion of the internal capsule, continue along the temporal white matter (Meyer's loop) surrounding the temporal horn of the ventricle, and posteriorly aim at occipital cortex located under the calcarine sulcus<a class="elsevierStyleCrossRefs" href="#bib0335">3,4</a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Oculomotor nervesThe nuclei of the common oculomotor nerve or third cranial nerve (CN III) are located in the periaqueductal region of the mesencephalon at the level of the superior quadrigeminal tubercles. A single central nucleus innervates both elevating muscles of the eyelid, the medial and inferior rectus muscles and the inferior oblique muscles are innervated from the homolateral nuclei, and the superior rectus muscles are innervated from the contralateral ones. The nerve leaves the mesencephalon via the interpeduncular cistern, runs through the superior cerebellar and posterior cerebral arteries running through the dural walls of the cavernous sinus, to reach its final destination on its superior edge.<a class="elsevierStyleCrossRefs" href="#bib0335">3–6</a>The nucleus of the CN IV (trochlear nerve) is in the mesencephalon, of inferior location to the CN III nucleus, behind the medial longitudinal fasciculus (MLF). Its fibers decussate in the mesencephalon and innervate the contralateral superior oblique muscle. The nerve emerges to the subarachnoid space at the level of the inferior quadrigeminal tubercles, running anteriorly through the ambient cistern between the mesencephalon and the tentorium. It runs through the dural walls of the cavernous sinus inferiorly to the CN III.<a class="elsevierStyleCrossRefs" href="#bib0335">3–6</a>The nucleus of the CN VI (abducens) is located in the dorsal region of the pons, in front of the floor of the fourth ventricle, and adjacent to the MLF. The majority of its fibers innervate the homolateral lateral rectus muscle, but a small group of axons run, via the MLF, to the contralateral nucleus, providing innervation for the lateral rectus on the other side too. The nerve emerges through the inferior side of the pons, ascends behind the clivus, enters the cavernous sinus, and runs inside the venous plexuses.<a class="elsevierStyleCrossRefs" href="#bib0335">3–6</a> After exiting the cavernous sinus, it reaches the orbit through the sphenoidal fissure. The first and the second branches of the trigeminal nerve also pierce the dural walls of the cavernous sinus.<a class="elsevierStyleCrossRef" href="#bib0340">4</a>The MLF runs along the anterior side of the mesencephalic aqueduct up to the anterior cord of the spinal cord. It is made up of association fibers that connect the motor nuclei of the homolateral CN III, IV, VI and XI, and each CN VI with the contralateral CN III. This structure is essential to coordinate the horizontal conjugate gaze.<a class="elsevierStyleCrossRefs" href="#bib0335">3,6,7</a> The MLF, the interstitial cells of Cajal and the CN III and IV participate in the coordination of the vertical gaze.<a class="elsevierStyleCrossRefs" href="#bib0350">6,7</a>Sympathetic and parasympathetic pathwaysThe Edinger–Westphal parasympathetic nucleus is located posterior to the CN III nucleus. It is made up of preganglionic parasympathetic neurons whose axons join the CN III fibers on their way toward the orbit. These fibers are in the periphery of the nerve. Inside the orbit they run toward the ciliary ganglion, from which the postganglionic fibers emerge to innervate the constricting muscles of the pupil and the muscle of the ciliary bodies.<a class="elsevierStyleCrossRefs" href="#bib0335">3,4,6,7</a>The sympathetic pathway is made up of three groups of neurons. The first neuron is located in the hypothalamus and its axons descend to the levels of C8-D2 of the spinal cord, where they meet the second neuron. From that location, the sympathetic pathway ascends to the superior cervical ganglion while running proximal to the carotid bifurcation. The third neuron is in this ganglion and its axons ascend, along with the adventitia of the internal carotid artery, toward the cavernous sinus, joining the first branch of the trigeminal nerve and aiming for the orbit.<a class="elsevierStyleCrossRefs" href="#bib0335">3,4,6–8</a>Imaging modalitiesSimple skull X-rayThe only indication of skull X-rays today is to confirm the presence of intraorbital or intracranial ferromagnetic foreign bodies, whose presence can contraindicate performing a magnetic resonance imaging (MRI) due to risk of mobilization.Orbital ultrasoundUltrasound performed with high frequency transducers, 7mHz or more—it is the modality of choice to assess the ocular globe.<a class="elsevierStyleCrossRefs" href="#bib0365">9–12</a> The globe is examined correctly through ophthalmoscopy, but in the presence of cataracts, vitreous hemorrhages, etc., which prevent seeing through, ultrasound can be of great help.<a class="elsevierStyleCrossRefs" href="#bib0375">11,13</a> It is especially useful in pediatrics, since it does not require sedation and can be used in the evolutionary control of the response to the treatment of some tumors.<a class="elsevierStyleCrossRefs" href="#bib0375">11,13</a>Doppler is useful in the assessment of alterations in flow dynamics and it allows the characterization of some vascular lesions. It can be used in the non-invasive assessment of carotid-cavernous fistulas, in which it is possible to observe thickening of an ophthalmic vein with inversion of flow direction and arterializations thereof (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>); it is useful for both the diagnosis prior to arteriography and the follow-up of those with low flow in which a decision is made not to intervene.<a class="elsevierStyleCrossRef" href="#bib0390">14</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Computed tomography and magnetic resonance imagingThey are the main imaging modalities for orbital and intracranial study.Computed tomography (CT) provides more information on the bony walls of the orbit, it visualizes calcifications clearly and it is the imaging modality of choice in the presence of ferromagnetic intraorbital foreign bodies that contraindicate the use of MRI.<a class="elsevierStyleCrossRef" href="#bib0395">15</a> Since it is fast and is widely available, it is the modality indicated in emergency contexts. The sequential study of the skull provides the necessary information in cases of urgent vascular and traumatic encephalic pathology.<a class="elsevierStyleCrossRef" href="#bib0400">16</a> Acquisition on multi-slice CT machines with reformatting on the coronal and sagittal planes allows a comprehensive assessment of facial and orbital traumatic lesions.MRI provides greater anatomic resolution and better tissue characterization, and good assessment of the signal differences among the different tissues; therefore, it is of choice in orbital studies.<a class="elsevierStyleCrossRef" href="#bib0405">17</a> If it cannot be conducted, it can be replaced by the CT scan with sufficient diagnostic guarantees on most occasions. It can be conducted with skull or surface antennas<a class="elsevierStyleCrossRef" href="#bib0405">17</a>; the latter provide better signal/noise relation, providing excellent anatomic details of the ocular globe during the examination, yet they are not enough to assess the orbital apex and the intracranial spread of the lesions.The correct assessment of the hypothalamus-hypophyseal region as well as the study of brain structures should be conducted through an MRI. The protocols will depend on the anatomical area studied.<a class="elsevierStyleCrossRef" href="#bib0410">18</a>Cranial CT-angiography or MRI are indicated in cases of suspicion of aneurysms or vascular malformations.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the CT and MRI study protocols used in our center.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>ArteriographyArteriography maintains its indication in selected cases of aneurysms, carotid-cavernous fistulas, varices or vascular malformations that require diagnostic confirmation and therapeutic procedures.<a class="elsevierStyleCrossRef" href="#bib0415">19</a> In highly vascularized orbital and intracranial tumors its partial embolization can prove beneficial prior to surgery.Clinical indications of imaging modalitiesThe first neurophthalmological goal is the clinical location of the lesion. The different symptomatology allows locating the origin of the pathology in each anatomic region and choosing the right imaging modality; it is possible to make a generic division of the ocular globe, orbit, parasellar region, middle cranial fossa and posterior cranial fossa. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> indicates the most appropriate imaging modalities to be used in each region. On many occasions, the use of one modality does not exclude the others, and findings often complement one another to be able to reach diagnosis.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Pathology of the ocular globeDoppler ultrasound is the best screening technique of ocular globe pathology, indicated to differentiate retinal detachment from vitreous hemorrhages, which are sometimes hard to assess through ophthalmoscopy.<a class="elsevierStyleCrossRefs" href="#bib0375">11,20</a> It is simple and easy to manage when trying to find foreign bodies, although extreme caution should be exercised if ocular globe rupture is suspected, since pressure on the ocular globe with the transducer could cause the extrusion of its content. In these cases, it is better to perform a CT-scan,<a class="elsevierStyleCrossRefs" href="#bib0370">10,12,20</a> that also allows us to assess, with high sensitivity, foreign bodies of different materials as well as the condition of the remaining orbital structures.<a class="elsevierStyleCrossRef" href="#bib0420">20</a>Ultrasound provides higher spatial resolution than MRI when looking for small ocular tumors, but the MRI is more precise for the assessment of sclerotic infiltration and retrobulbar tumor spread.<a class="elsevierStyleCrossRefs" href="#bib0380">12,21</a>The most common intraocular tumor in pediatric age is retinoblastoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), whose characteristic clinical sign is leukocoria. Calcifications are present in up to 90–95 per cent of retinoblastomas,<a class="elsevierStyleCrossRefs" href="#bib0385">13,22,23</a> in general in the posterior portion of the globe. Both the ultrasound and the CT scan are highly sensitive to detect them, identifying calcifications of 2 or more mm in thickness. However, the MRI shows better the tumor characteristics, the retrobulbar infiltration and the spread of the disease to the central nervous system, as well as the presence of associated pineal or suprasellar retinoblastomas.<a class="elsevierStyleCrossRefs" href="#bib0430">22,24</a> Today, despite its high sensitivity, the orbital CT scan is not adviseable considering the high radiation that it would mean for the orbit of pediatric patients.<a class="elsevierStyleCrossRef" href="#bib0440">24</a> There are studies that show that the combination of ophthalmoscopy, ultrasound and MRI manages to detect calcifications with the same percentage as CT-scan.<a class="elsevierStyleCrossRef" href="#bib0435">23</a> The most sensitive MRI sequence for the detection of calcifications is the T2-weighted sequence*.<a class="elsevierStyleCrossRef" href="#bib0435">23</a> Recent research supports the utility of diffusion sequences in the diagnosis of retinoblastomas, since they show greater restriction to diffusion than other ocular lesions, and also allow us to monitor the response to treatment by differentiating viable tumor tissue from necrotic tissue.<a class="elsevierStyleCrossRefs" href="#bib0445">25,26</a><elsevierMultimedia ident="fig0015"></elsevierMultimedia>Choroidal melanoma as primary tumor (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) and metastasis (breast and lung, mainly) are the most common ocular tumors in the adult population,<a class="elsevierStyleCrossRefs" href="#bib0370">10,11,27,28</a> but other lesions can appear, such as hemangiomas, hemangioblastomas or granulomatous lesions. The ultrasound is very sensitive for the detection of small tumors, but the MRI is the modality of choice for its study, since it contributes some characteristic details and allows assessing whether there is extraocular spread.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>On the ultrasounds, melanomas look hypoechogenic with the sign of choroidal excavation, characteristic (though not always present) and indicative of local invasion. By applying Doppler, they show high vascularization.<a class="elsevierStyleCrossRefs" href="#bib0370">10,27</a> Metastases are hyperechogenic, with greater vascularization in the Doppler study, and they can be multiple. The most significant characteristic of melanomas on the MRI is hyperintensity on T1 and hypointensity on T2, due to its melanin content: the more melanin content, the higher the signal intensity is on the T1-weighted image, and according to some authors, this leads to worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0405">17</a> Amelanotic melanomas do not show hyperintensity on T1, which makes it hard to make a differential diagnosis with other tumors.<a class="elsevierStyleCrossRef" href="#bib0465">29</a> Metastases are not visualized as hyperintense on T1 unless there is a hemorrhagic component or high mucoid content inside them.<a class="elsevierStyleCrossRef" href="#bib0455">27</a> Research conducted with diffusion shows great diffusion restriction, with a reduced apparent diffusion coefficient in melanomas with respect to other lesions. Since today the treatment of choice is radiosurgery, monitoring the apparent diffusion coefficient in serial studies allows us to assess how the response to treatment really is.<a class="elsevierStyleCrossRef" href="#bib0470">30</a>The presence of drusen in the optic nerve head can cause elevation of the papilla and blurring of its edges, and on the ophthalmoscopy it can be mistaken for papillary edema. Both on the ultrasound and the CT scan, asymmetrical bilateral or unilateral calcified nodules can be observed.<a class="elsevierStyleCrossRefs" href="#bib0375">11,12,20</a>Optic neuritisOptic neuritis is a clinical diagnosis that leads to the unilateral loss of vision, pain, afferent pupillary defect and campimetric defect.<a class="elsevierStyleCrossRef" href="#bib0355">7</a> Imaging tests of the optic nerve should be conducted whenever there is indication of optic neuritis that cannot be explained by glaucoma, ischemia or toxic, metabolic, infectious or hereditary causes.<a class="elsevierStyleCrossRef" href="#bib0475">31</a>Since optic neuritis can be the initial manifestation in 15–25 per cent of the patients with multiple sclerosis, and up to 75 per cent of these patients will have at least one episode of optic neuritis, the cranial MRI is recommended in young patients with acute retrobulbar optic neuritis who do not show the above mentioned etiologic factors, seeking lesions typical of demyelinating disease.<a class="elsevierStyleCrossRef" href="#bib0475">31</a> Brain MRI is the best isolated test to assess risk of future multiple sclerosis and help in the decision of prescribing immunomodulatory therapy.<a class="elsevierStyleCrossRefs" href="#bib0480">32,33</a>The risk of developing the disease is up to 38 per cent at 10 years and 50 per cent at 15 years in patients with hyperintense lesions on the MRI.<a class="elsevierStyleCrossRefs" href="#bib0475">31,33,34</a> The risk of developing the disease with a normal MRI is much less, 22 per cent at 10 years.<a class="elsevierStyleCrossRefs" href="#bib0480">32,34</a>Compressive optic neuropathyIt usually starts with slow and progressive loss of vision. It can be due to thyroid ophthalmopathy due to intraorbital space involvement, to the compression of the optic nerve fibers due to tumor or infiltrative causes of the nerve itself, or to lesions occupying the intraconal space<a class="elsevierStyleCrossRefs" href="#bib0340">4,7,35,36</a> (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Increase of intracranial pressure, whether tumor or idiopathic, causes an increase of the cerebrospinal fluid in the optic nerve sheath and the compression of its fibers with vision alterations.<a class="elsevierStyleCrossRefs" href="#bib0505">37,38</a>Damage is generally unilateral, with loss of the monocular visual field, except in the thyroid ophthalmopathy and cranial hypertension, where it is usually bilateral.<a class="elsevierStyleCrossRef" href="#bib0495">35</a>Traumas can cause acute decrease of vision due to an optic nerve lesion of a direct cause, avulsion of the optic nerve itself, laceration by bony fragments, compression, or intraorbital hematomas in the nerve sheath<a class="elsevierStyleCrossRef" href="#bib0515">39</a> (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Brain contusions in the frontal lobes can also damage the optic nerves in their intracranial trajectory.<a class="elsevierStyleCrossRef" href="#bib0495">35</a><elsevierMultimedia ident="fig0025"></elsevierMultimedia>The MRI is the modality of choice for the assessment of the orbit, due to its greater capacity to discriminate soft tissues.<a class="elsevierStyleCrossRefs" href="#bib0405">17,40</a> The T1-weighted sequence is essential, since most orbital lesions are hypointense with respect to fat, which allows the adequate assessment of their edges. T2 and T1 sequences with gadolinium, with or without fat suppression, provide differentiating data about some tumors (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).<elsevierMultimedia ident="fig0030"></elsevierMultimedia>Diffusion sequences can help differentiate some orbital tumors. Some studies have proven that optic nerve gliomas show apparent diffusion coefficient values that are significantly lower than meningiomas.<a class="elsevierStyleCrossRef" href="#bib0405">17</a> Also, lymphoproliferative diseases (lymphoma) cause greater diffusion restriction than inflammatory diseases (inflammatory pseudotumor).<a class="elsevierStyleCrossRefs" href="#bib0525">41,42</a>The CT scan is more useful for the assessment of bony alterations, being the modality of choice in orbital traumas and for the detection of calcifications (present in up to 33 per cent of nerve sheath meningiomas)<a class="elsevierStyleCrossRef" href="#bib0405">17</a> or phleboliths in cavernous hemangiomas and lymphangiomas.The presence of bilateral papilledema requires an urgent CT scan in order to seek intracranial massess or hydrocephaly as causes of the cranial hypertension. In the absence of findings, the angio-CT can be indicated to rule out thrombosis of the venous sinus.<a class="elsevierStyleCrossRefs" href="#bib0355">7,43</a>DiplopiaBinocular diplopia occurs as a result of misalignment of the visual axes, resulting in the images coming from each eye not fusing in the brain and thus originating double vision. It can have a restrictive cause and then the lesion is located in the orbit, or a nervous cause with the lesion located in the CN nuclei or their trajectory, whether due to nerve intrinsic pathology or compression in its trajectory through the basal cisterns<a class="elsevierStyleCrossRefs" href="#bib0540">44,45</a> (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Restrictive diplopiaThyroid ophthalmopathy and traumas are the most common causes of restrictive diplopia.Thyroid ophthalmopathy (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>) starts with extraocular muscle enlargement, usually bilateral, but asymmetrical. The muscles most commonly affected are the internal and inferior rectus muscles, and more rarely the lateral rectus muscle.<a class="elsevierStyleCrossRefs" href="#bib0500">36,45</a><elsevierMultimedia ident="fig0035"></elsevierMultimedia>The orbital CT scan is included in most thyroid ophthalmopathy diagnostic protocols.<a class="elsevierStyleCrossRefs" href="#bib0500">36,46</a> Axial slices assess the degree of exophthalmos and the increase of orbital fat; coronal slices are essential to compare the volume of homonymous muscles in both eyes and their size variations in serial controls, as well as to monitor the response to treatment. The CT scan makes adequate assessments of the orbital walls before planning decompressive surgery.<a class="elsevierStyleCrossRefs" href="#bib0500">36,40,46</a> The administration of iodinated contrast is not useful and should be avoided.<a class="elsevierStyleCrossRefs" href="#bib0400">16,47</a>The MRI allows us to differentiate the acute from the chronic stages of the disease. In the acute stage, muscular edema causes hypersignal on the T2-weighted sequences with fat suppression and STIR, and in the fibrosis stage, the muscles are hypointense in T1 and T2, with hyperintense foci in T1, representative of fat infiltration.<a class="elsevierStyleCrossRefs" href="#bib0520">40,46</a> A good correlation between the signal pattern in T2 and the reversibility of diplopia has been described, when seeing how the cases with homogeneous hypersignal show better responses to treatment than whenever the signal is hypointense and heterogeneous.<a class="elsevierStyleCrossRef" href="#bib0560">48</a>Orbital wall fractures, especially those on the orbital floor or the lamina papyracea (blow-out), can cause ocular movements restriction, and therefore diplopia due to edema or hemorrhages in the orbital fat that pulls from the muscle, also muscle swelling or herniation of the muscular center through the fracture (in general of the inferior rectus). This is why it is crucial to assess the condition of the extraocular muscles in the CT scans of patients with facial traumas.<a class="elsevierStyleCrossRef" href="#bib0565">49</a> The coronal plane provides more information for the detection of muscle herniations (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>) and it is essential when making the decision of conducting urgent or delayed surgery.<a class="elsevierStyleCrossRefs" href="#bib0570">50,51</a><elsevierMultimedia ident="fig0040"></elsevierMultimedia>Other damage to the extraocular muscle can cause movement restriction and diplopia. The differentiation is based mainly on the morphological assessment of the lesions.<a class="elsevierStyleCrossRef" href="#bib0520">40</a>Nervous diplopiaDiplopia due to paralysis of a CN can be due to ischemia in the vasculature of the nerve itself or to small infarctions in the mesencephalic nuclei, due to trauma, aneurysms in the circle of Willis arteries or neoplasms that can compress the nerves along their trajectory.<a class="elsevierStyleCrossRefs" href="#bib0545">45,52–54</a>The isolated paralyzes of some CN in patients over 50 years old with a history of diabetes, high blood pressure or vascular diseases are usually of microvascular origin and there is no need to conduct imaging modalities.<a class="elsevierStyleCrossRefs" href="#bib0535">43,53,55–57</a> They are usually resolved completely in less than 3 months. If they are not resolved or if we are dealing with a young patient without vascular risk factors, neuroradiological tests are indicated, being the MRI the modality of choice<a class="elsevierStyleCrossRef" href="#bib0610">58</a> (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>a–c). In such case, it would be good to administer contrast.<a class="elsevierStyleCrossRef" href="#bib0535">43</a><elsevierMultimedia ident="fig0045"></elsevierMultimedia>CN IV, due to its length, and CN VI, due to its ascending trajectory posterior to the clivus, are vulnerable to cranial traumas.<a class="elsevierStyleCrossRefs" href="#bib0535">43,45,54</a> Bilateral damage to the CN VI can be due to cranial hypertension or tumor-related compression.<a class="elsevierStyleCrossRefs" href="#bib0535">43,53</a> The initial imaging modality is the CT scan, since these patients are usually under urgent examination.The complete paralysis of the CN III is associated to pupillary dysfunction or incomplete paralysis with or without pupillary damage, requires conducting an urgent angio-CT scan or angio-MRI to rule out aneurysm, usually located in the junction between the posterior communicating artery and the internal carotid artery.<a class="elsevierStyleCrossRefs" href="#bib0595">55,56,59</a> The angio-CT scan, due to its greater availability in the ER context is the most commonly used modality (<a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a>). The intracavernous internal carotid artery aneurysm commonly causes CN VI paralysis due to its proximity within the cavernous sinus.<a class="elsevierStyleCrossRef" href="#bib0620">60</a><elsevierMultimedia ident="fig0050"></elsevierMultimedia>Neoplasms, severe cranial traumas, or large aneurysms can cause damage to several CNs.<a class="elsevierStyleCrossRef" href="#bib0590">54</a> Conducting either a CT scan or an MRI will depend on their availability within the patient's clinical context.The cavernous sinus diseases (carotid-cavernous fistula, dural fistula, thrombosis) can cause damage to several CNs or CN VI along with the sympathetic pathway, due to their proximity to the internal carotid artery.<a class="elsevierStyleCrossRefs" href="#bib0335">3,5,45</a> The MRI is the most suitable modality for its study. The Tolosa–Hunt syndrome (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>d–f) is a clinical diagnosis consisting of orbital pain with homolateral ophthalmoplegia (more frequently CN III, followed by CN IV and VI) that affects the cavernous sinus and can spread toward the orbital apex.<a class="elsevierStyleCrossRefs" href="#bib0620">60,61</a> On the MRI it is possible to observe cavernous sinus thickening, bulging of its lateral edge, and intense enhancement after the administration of gadolinium. Corticoid therapy leads to clinical and radiological improvement. There are times that the findings can be subtle. To make sure that its diagnosis is accurate, other cavernous sinus damage causes should be ruled out here.<a class="elsevierStyleCrossRef" href="#bib0630">62</a>Internuclear ophthalmoplegia consists of the loss or limitation of adduction in one eye and horizontal nystagmus during the abduction of the other eye.<a class="elsevierStyleCrossRef" href="#bib0350">6</a> The MRI shows the lesions in MLF location, being the most common causes multiple sclerosis in young people and ischemia in the elderly.<a class="elsevierStyleCrossRefs" href="#bib0340">4,6</a>Bitemporal campimetric defectsIn the bitemporal campimetric defects, the pathology is in the chiasmatic region, where the decussation of the nasal fibers is consistent with temporal hemiretinas.Tumors in the sellar and parasellar region (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 11</a>), among them, the hypophyseal adenoma being the most common can compress the optic chiasm (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). Chiasm gliomas themselves can cause asymmetric bitemporal campimetric defects depending on the fibers damaged. Intrasellar lesions affect the superior temporal fields, and hypothalamic lesions or those of the third ventricle region damage the inferior ones.<a class="elsevierStyleCrossRef" href="#bib0335">3</a><elsevierMultimedia ident="fig0055"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia>The modality of choice for its assessment is the MRI focused on the hypothalamus-hypophysis region.<a class="elsevierStyleCrossRef" href="#bib0410">18</a>Homonymous hemianopsiaThe homonymous defects of the visual field involve lesions of the retrochiasmatic visual pathway<a class="elsevierStyleCrossRef" href="#bib0335">3</a> (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). If hemianopsia is congruent, the lesion will be found in the occipital cortex or close to it, if it is not, the lesion should be looked for in the optic tracts, the lateral geniculate ganglion or Meyer's loop.<a class="elsevierStyleCrossRef" href="#bib0355">7</a>Cerebral vascular accidents are the most common cause of isolated homonymous hemianopsias<a class="elsevierStyleCrossRef" href="#bib0635">63</a> (<a class="elsevierStyleCrossRef" href="#fig0060">Fig. 12</a>). These defects should always be studied radiologically, except when they are clearly associated with an old cerebral vascular accident. Given that strokes have an acute clinical presentation, the cranial CT scan is the initial modality to assess these cases, especially if hemorrhage is suspected. When the cause is thought not to be vascular (tumors, demyelinating disease, etc.), the cranial MRI provides more information to be able to reach the correct diagnosis.<elsevierMultimedia ident="fig0060"></elsevierMultimedia>Horner's syndromeDamage to the sympathetic pathway occurs with mild ptosis, miosis and, at times, anhidrosis.<a class="elsevierStyleCrossRefs" href="#bib0335">3,4</a> On suspicion that the first neuron is affected with cerebral symptoms, both an MRI and a brain angio-MRI should be conducted, and in the absence of brain symptoms, a cervical MRI should the modality of choice. In the former case we could find ischemic, inflammatory or tumor lesions in the hypothalamic region and, if there is medullary damage, we can find syringohydromyelia or medullary neoplasms. To study the pathology that affects the preganglionic neurons, one CT scan of the neck, including the cervicothoracic junction, is more suitable, since it is possible to find tumors of the pulmonary apex, endothoracic goiter, schwannomas, or neuroblastic tumors, and in cases where there is damage to the postganglionic neurons, the CT scan or the MRI should be conducted including vascular sequences in order to rule out arterial pathology, such as carotid dissection or lesions in the sellar and parasellar regions.<a class="elsevierStyleCrossRefs" href="#bib0360">8,64</a>ConclusionsKnowledge of the optic pathway anatomy, the CNs and the autonomous pathways involved in the motility and correct clinical information are crucial to be able to select and plan radiological examinations. The classification of the pathology based on the most relevant clinical sign or symptom in each case will allow us to select the most suitable imaging modality, while taking into account the most common differential diagnoses in each group of patients.Authors’ contributions<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Manager of the integrity of the study: ACVM.</li><li class="elsevierStyleListItem" id="lsti0010">2.Study Idea: ACVM.</li><li class="elsevierStyleListItem" id="lsti0015">3.Study Design: ACVM.</li><li class="elsevierStyleListItem" id="lsti0020">4.Data Mining: ACVM, PSM, CBL and BIH.</li><li class="elsevierStyleListItem" id="lsti0025">5.Data Analysis and Interpretation: ACVM, PSM, CBL and BIH.</li><li class="elsevierStyleListItem" id="lsti0030">6.Statistical analyses N/A.</li><li class="elsevierStyleListItem" id="lsti0035">7.Reference: ACVM, PSM, CBL and BIH.</li><li class="elsevierStyleListItem" id="lsti0040">8.Writing: ACVM.</li><li class="elsevierStyleListItem" id="lsti0045">9.Critical review of the manuscript with intellectually relevant remarks: ACVM, PSM, CBL and BIH.</li><li class="elsevierStyleListItem" id="lsti0050">10.Approval of final version: ACVM, PSM, CBL and BIH.</li></ul>Conflicts of interestThe authors declare no conflict of interests associated with this article whatsoever." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1022322" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec980500" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1022321" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec980499" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Visual pathways" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Oculomotor nerves" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Sympathetic and parasympathetic pathways" ] ] ] 5 => array:3 [ "identificador" => "sec0025" "titulo" => "Imaging modalities" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Simple skull X-ray" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Orbital ultrasound" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Computed tomography and magnetic resonance imaging" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Arteriography" ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Clinical indications of imaging modalities" ] 7 => array:3 [ "identificador" => "sec0055" "titulo" => "Pathology of the ocular globe" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Optic neuritis" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Compressive optic neuropathy" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Diplopia" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Restrictive diplopia" ] 4 => array:2 [ "identificador" => "sec0080" "titulo" => "Nervous diplopia" ] 5 => array:2 [ "identificador" => "sec0085" "titulo" => "Bitemporal campimetric defects" ] 6 => array:2 [ "identificador" => "sec0090" "titulo" => "Homonymous hemianopsia" ] 7 => array:2 [ "identificador" => "sec0095" "titulo" => "Horner's syndrome" ] ] ] 8 => array:2 [ "identificador" => "sec0100" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0105" "titulo" => "Authors’ contributions" ] 10 => array:2 [ "identificador" => "sec0110" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack345205" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-02" "fechaAceptado" => "2017-11-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec980500" "palabras" => array:4 [ 0 => "Orbit" 1 => "Visual pathways" 2 => "Ophthalmologic imaging techniques" 3 => "Ocular diseases" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec980499" "palabras" => array:4 [ 0 => "Órbita" 1 => "Vías visuales" 2 => "Técnicas de imagen oftalmológicas" 3 => "Enfermedades oculares" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Neuro-ophthalmology is a field combining neurology and ophthalmology that studies diseases that affect the visual system and the mechanisms that control eye movement and pupil function. Imaging tests make it possible to thoroughly assess the relevant anatomy and disease of the structures that make up the visual pathway, the nerves that control eye and pupil movement, and the orbital structures themselves. This article is divided into three sections (review of the anatomy, appropriate imaging techniques, and evaluation of disease according to clinical symptoms), with the aim of providing useful tools that will enable radiologists to choose the best imaging technique for the differential diagnosis of patients’ problems to reach the correct diagnosis of their disease." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La neuroftalmología es la parte de la neurología y la oftalmología que se encarga del estudio de las enfermedades que afectan al sistema visual y a los mecanismos que controlan la motilidad ocular y la función pupilar. Las pruebas de imagen permiten realizar una adecuada valoración anatómica y patológica de las estructuras que conforman la vía visual, los nervios que controlan la motilidad ocular y pupilar, y las propias estructuras orbitarias. Este artículo se divide en tres apartados (recuerdo anatómico, técnicas de imagen apropiadas y valoración patológica en función de la sintomatología clínica) con el propósito de proporcionar herramientas útiles que permitan al radiólogo elegir en cada momento la técnica de imagen más adecuada para el correcto diagnóstico de las enfermedades y un ajustado diagnóstico diferencial." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Vela Marín AC, Seral Moral P, Bernal Lafuente C, Izquierdo Hernández B. Diagnóstico por la imagen en neuroftalmología. Radiología. 2018;60:190–207." ] ] "multimedia" => array:18 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1896 "Ancho" => 2500 "Tamanyo" => 585412 ] ] "descripcion" => array:1 [ "en" => "(a) Drawing representing the optic pathways. (b) Drawing showing the location of the nuclei of the oculomotor cranial pairs relative to the mesencephalon and the pons. (c) Schematic drawing of the correlations of the cranial pairs with the cavernous sinus and the intracavernous internal carotid artery. a: Retina; b: optic nerve; c: optic chiasm; d: optic tract; e: lateral geniculate ganglion; f: inferior geniculocalcarine tracts or Meyer's loop; g: superior geniculocalcarine tracts; h: occipital cortex; II: optic nerve; III: common oculomotor nerve; IV: trochlear nerve; VI: abducens nerve; V1: first branch of the trigeminal nerve; V2: second branch of the trigeminal nerve." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1497 "Ancho" => 2000 "Tamanyo" => 289026 ] ] "descripcion" => array:1 [ "en" => "Carotid-cavernous fistula. Forty-eight-year-old woman who, after falling down the stairs, presents with progressive left exophthalmos and palpebral swelling. The Color Doppler ultrasound (a and b) shows the thickening of the superior ophthalmic vein with arterialized flow. Coronal (c) and axial (d) slices of orbital CT scan without contrast showing thickening of the left extraocular muscles due to congestive edema and thickening of the superior ophthalmic vein (arrow); compare with the contralateral one. Arteriographic confirmation was made and treatment administered through embolization with no success, and later closure of carotid above and below the fistula." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1649 "Ancho" => 2000 "Tamanyo" => 280930 ] ] "descripcion" => array:1 [ "en" => "Retinoblastoma. Ocular ultrasound (a) and T2 axial slice with fat saturation (b) in a two-month-old infant with leukocoria. The ultrasound shows one lobulated, heterogeneous mass, with hyper-refringent images indicative of calcifications. The T2 the image is highly hypointense. Both modalities rule out retrobulbar invasion. Bilateral retinoblastoma. T2 axial slices with fat saturation (c) and T1 with fat saturation with gadolinium (d) in a nine-month-old infant with right leukocoria. Right intraocular lesion hypointense in T2 with homogeneous enhancement after the administration of gadolinium, that produces retinal detachment without invasion of retrobulbar structures. It is possible to observe a small image in the left ocular globe with similar characteristics in the nasal region (arrow)." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1493 "Ancho" => 2000 "Tamanyo" => 285136 ] ] "descripcion" => array:1 [ "en" => "Melanoma. Ocular ultrasound (a) and T2 axial slice with fat saturation (b) in a 58-year-old male who presented to the ER with blurry vision. Ophthalmoscopy revealed one slightly pigmented, elevated peripapillary mass. The ultrasound reveals one small lenticular mass with the choroidal excavation sign (arrows), and the T2 MRI slice shows the hypointense lesion adjacent to the papilla. Melanoma. T1 (c) and T2 axial slices with fat saturation (d) of a 73-year-old patient with one prominent mass in the lower quadrants revealed by the ophthalmoscopy. On the MRI, the lesion shows the characteristics typical of melanomas, hyperintense in T1 and hypointense in T2." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1894 "Ancho" => 2500 "Tamanyo" => 335579 ] ] "descripcion" => array:1 [ "en" => "Orbital trauma. Axial slice with bone window (a) and sagittal reformatting with soft tissue algorithm (b and c) in a 26-year-old woman with facial trauma after a recent traffic accident. She had multiple fractures in her left maxillary sinus and orbit, with multi-fragmented fracture in her orbital roof, revealing one fragment (arrow) in the optic foramen that caused an irreversible lesion of the optic nerve despite urgent treatment. Orbital trauma. Axial slice (d) and sagittal reformatting (e) of CT scan performed on an 80-year-old woman after falling down the stairs, with periorbital hematoma and limitation of ocular motility. Thickening and fraying of retrobulbar and perineural fat compatible with hematoma, which was immediately drained." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1629 "Ancho" => 2667 "Tamanyo" => 434583 ] ] "descripcion" => array:1 [ "en" => "Optic nerve glioma. T2 axial slices with fat saturation (a) and T1 with fat saturation with gadolinium (b) in a patient with reduced visual acuity and papillary edema. Fusiform thickening of the right optic nerve that impacts on the papilla, hyperintense in T2 with homogeneous enhancement after contrast administration. Optic nerve sheath meningioma. T1 axial slice with fat saturation (c) with gadolinium and T1 sagittal slice with fat saturation (d) in a young man with slow, progressive loss of vision and signs of severe left neuropathy in evoked potentials. Tubular thickening of the left optic nerve sheath that surrounds and constricts the nerve and enhances intensely with gadolinium, spreading through the orbital foramen to the middle cranial fossa (arrow). Venolymphatic malformation. T2 axial slices with fat saturation (e) and T1 (f) in a 2-year-old girl with right ocular proptosis. Right orbital mass with intraconal and extraconal component, with cystic images and fluid/fluid levels due to the hemorrhagic component of the cysts. Cavernous vascular malformation. T2 axial slice with fat saturation (g) and T1 sagittal slice with fat saturation with gadolinium (h) in a 60-year-old patient with reduced visual acuity in his left eye. Rounded, well-established mass in the orbital apex, hyperintense in T2 and intensely enhanced in the slice with contrast that compresses the optic nerve." ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1901 "Ancho" => 2000 "Tamanyo" => 333592 ] ] "descripcion" => array:1 [ "en" => "Thyroid orbitopathy. Coronal (a and b) and axial slices (c and d) of CT scan without contrast in a 43-year-old woman with hyperthyroidism. Fusiform thickening of the bilateral and asymmetric extraocular muscles, especially of the inferior recti and, to a lesser extent, of the left medial and right lateral rectus. We can also see the inflammatory infiltration of intraconal fat. T1 and T2 axial slices with fat saturation (e and f) and T1 orbital and coronal slices with gadolinium of hypophysis (g) in a patient with hyperthyroidism. Fusiform thickening of left internal rectus muscle with hypersignal in T2 sequence with fat saturation, hypersignal that is also observed in the right medial rectus, indicative of the acute stage of the disease. As an incidental finding, there is one hypophyseal macroadenoma that superiorly displaces the chiasm." ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1635 "Ancho" => 2000 "Tamanyo" => 275825 ] ] "descripcion" => array:1 [ "en" => "Blow-out fracture of lamina papyracea with muscle herniation. Axial (a) and coronal (b) CT slices and T1coronal slices (c and d) in a 13-year-old girl who, after suffering a head trauma following run over accident, presents complete adduction and partial abduction deficits in her left eye with diplopia. The CT slices show the fracture line in the lamina papyracea, occupation of the middle ethmoidal cell, and irregular morphology of the internal rectus muscle on her left side. The MRI slices show the change in shape and orientation of the internal rectus muscle with respect to the contralateral one, with “bow-tie” morphology due to muscle herniation in the ethmoidal cell." ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 1801 "Ancho" => 2533 "Tamanyo" => 411034 ] ] "descripcion" => array:1 [ "en" => "Patient with multiple sclerosis. DP (a), FLAIR (b) and FLAIR (c) axial slices in a 27-year-old woman with right cranial nerve VI palsy. The MRI slices show one hyperintense demyelinating plate adjacent to the floor of the fourth ventricle in the location of the cranial nerve VI nucleus. The complete study showed typical periventricular and juxtacortical demyelinating lesions. Tolosa–Hunt syndrome. Coronal T2 (d), axial (e) and coronal (f) slices with gadolinium of a patient with headache, left palpebral ptosis, and palsy of the left cranial nerves III and IV. Treatment with corticoids led to a rapid clinical improvement. The MRI slices show thickening of left cavernous sinus, with intense enhancement, spreading toward the orbital apex." ] ] 9 => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 1857 "Ancho" => 2533 "Tamanyo" => 407404 ] ] "descripcion" => array:1 [ "en" => "Aneurysms. Axial (a), coronal (b) and 3D (c) reformatting of maximum intensity projection of an angio-CT scan conducted in a 50-year-old woman who, after suffering from progressive headache for several weeks, presents to the ER with complete palsy of the right cranial nerve III and mydriatic pupil. Small aneurysm in the junction between the right internal carotid artery and the posterior communicating artery in contact with the cranial nerve III. Axial (d) and coronal (e) MIP reformatting of angio-CT scan and diagnostic arteriography images (f) and after treatment (g) of a 48-year-old patient who presented to the ER with intense, headache of two-day duration with vomits and left cranial nerve VI palsy. One aneurysm is identified in the intracavernous internal carotid artery justifying the compression of the cranial nerve VI. It is confirmed through the arteriography, and the complete closure of the aneurysm is confirmed after the embolization." ] ] 10 => array:7 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 1849 "Ancho" => 2533 "Tamanyo" => 422227 ] ] "descripcion" => array:1 [ "en" => "Hypophyseal macroadenoma. T1 coronal (a), and coronal (b) and T1 sagittal (c) slices with gadolinium, in a 59-year-old patient with bitemporal hemianopsia. Hypophyseal mass with intrasellar and suprasellar component, with “snowman” morphology compressing the optic chiasm (arrows). The macroadenoma shows one hyperintense cystic component in T1 that does not enhance, unlike the rest of the lesion. Craniopharyingioma. T1 sagittal (d) and axial FLAIR (e) and SPGRT1 (T1 spoiled gradient) slices with gadolinium (f), in a 61-year-old patient with right and left temporal visual field damage. Suprasellar mass with cystic lesion and solid component that enhances with gadolinium. Note that, unlike the macroadenoma, the lesion compresses the chiasm from above, and the hypophysis is compressed on the bottom of the sella turcica (arrow)." ] ] 11 => array:7 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 2101 "Ancho" => 2000 "Tamanyo" => 271793 ] ] "descripcion" => array:1 [ "en" => "Acute occipital infarction. Axial FLAIR (a) and diffusion (b) slices in a patient with sudden alteration of vision, and confirmation of right inferior homonymous quadrantanopia. Hyperintense lesion in the left occipital cortex shining in diffusion. The lesion was located above the calcarine sulcus. Acute occipital hemorrhages. CT axial (c) slices in a 75-year-old patient that presents to the ER with headache, vomits and left homonymous hemianopsia, and CT axial (d) slice of the same patient presenting one year later with total blindness. In the first study, the right occipital acute hematoma can be seen, which justifies the presence of left hemianopsia. In the subsequent study, the right occipital encephalomalacia residual to the prior hematoma can be seen plus one new left occipital hematoma that by causing the right hemianopsia is causing total blindness." ] ] 12 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visual field \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hemiretina \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chiasm \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tract \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Geniculate ganglion \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Optic radiations \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Occipital cortex \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temporal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nasal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Direct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nasal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Temporal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Homolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Homolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Homolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Homolateral \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Superior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inferior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Includes Meyer's loop \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inferior to the calcarine sulcus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superior to the calcarine sulcus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Macula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cross \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both sides of the calcarine sulcus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Direct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737411.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Scheme-summary of the direction of the visual pathways." ] ] 13 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CT machine: Toshiba Aquilion 64. Toshiba Medical Systems.MRI machine: Signa Excite 1.5. General Electric Healthcare. Milwakee. Wisconsin, USA.EPI: echo-planar imaging; Fast SPGR: fast spoiled gradient; FS: fat sat (fat saturation); MIP: maximum intensity projection; MPR: multiplane reformatting; SE: spin echo; SS coherent: steady state coherent; STIR: short tau inversion recovery; SWI: susceptibility-weighted imaging; T2*: weighted gradient echo in T2; TOF: time of flight." "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CT-scan protocol</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sequential CT-scan \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Helical CT-scan \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Angio-CT-scan \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brain structures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orbit and facial structures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerebral and supra-aortic trunks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reconstruction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reconstruction: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Slice thickness: 5–8mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Slice thickness: 0.5–1mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Slice thickness: 0.5–1mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Advance: 5mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Interspace: 0.3–0.8mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Interspace: 0.3–0.8mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Algorithm: brain and bone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Algorithm: soft tissues and bone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Algorithm: soft tissues and bone \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reformatting: axial, sagittal and coronal MPR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reformatting: axial, sagittal and coronal MIP \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(1–2mm every 2mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(7–10mm every 5–8mm) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Administration of contrast: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Administration of contrast: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Administration of contrast: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tumor, infectious or vascular pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumor, infectious or vascular pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50cc high concentration at 5ml/s \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50cc physiological saline solution \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737414.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MRI protocol</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cranial MRI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Orbital MRI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hypophyseal MRI \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Skull (orbit) or surface (balloon) antenna \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial T1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sagittal and coronal T1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FLAIR T2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial T2FS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sagittal and coronal T1 with gadolinium \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diffusion (factor B: 1000) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Coronal STIR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Coronal T2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gradient Echo: T2*, SWI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T1FS with gadolinium (axial, coronal, sagittal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Slice thickness: 2–3mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Slice thickness: 2–3mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Matrix: 256×256; 512×512 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Matrix: 256×256 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complementary sequences: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complementary sequences: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Complementary sequences: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3D SS Coherent: cranial pairs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dynamic fast SPGR FS: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3DT1 with gadolinium \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Angio-MRI 3D TOF: aneurysms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumors vascular lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T2 sagittal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3DT1 with gadolinium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diffusion SE, EPI, T2* calcifications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737417.png" ] ] ] ] "descripcion" => array:1 [ "en" => "CT scan and MRI protocols in the neuro-ophtalmology unit at the Hospital Universitario Miguel Servet, Zaragoza, Spain." ] ] 14 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ocular globe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Choice \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ultrasound<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Foreign body/calcifications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CT-scan<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Soft tissues \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MRI<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trauma, foreign body, \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CT-scan<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">bony lesions, calcifications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MRI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Graves’ disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Orbit (optic nerve) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Exophthalmos, suspicion of tumors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MRI<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CT-scan \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alteration of flow dynamics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Doppler<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arteriography \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CT-scan/MRI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sellar and parasellar region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MRI<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chiasm (hypothalamus-hypophyseal region) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Base of skull \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CT-scan<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vascular pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Angio-CT scan/MRI<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retrochiasmatic pathways \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MRI<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior fossa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CT-scan<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737415.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Modality of choice." ] ] ] "descripcion" => array:1 [ "en" => "Indications of the imaging modalities in neuro-ophthalmology based on anatomical areas and pathology." ] ] 15 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Thyroid orbitopathy</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Tumor/infiltration of nerve</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tumor: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optic nerve glioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inflammatory: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optic nerve sheath meningioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inflammatory pseudotumor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lymphoproliferative syndromes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Intraconal masses</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cavernous vascular malformation<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Inflammation/infection</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Venolymphatic malformation<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inflammatory pseudotumor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orbital varicose vein \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granulomatous polyangiitis<a class="elsevierStyleCrossRef" href="#tblfn0020">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High flow arteriovenous malformation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orbital cellulitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tumors: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leukemia/lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orbital abscess \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cranial spread of meningioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Intracranial hypertension</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Traumas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Direct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Optic nerve avulsion and laceration<a class="elsevierStyleCrossRef" href="#tblfn0025">d</a></td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Indirect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Perineural hematoma</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737416.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Also known as cavernous hemangioma." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Also known as cystic lymphangioma." ] 2 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "c" "nota" => "Formerly known as Wegener's granulomatosis." ] 3 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "d" "nota" => "It is not cause for compressive optic neuropathy as such, but the lesion includes nervous fiber tears." ] ] ] "descripcion" => array:1 [ "en" => "Causes for compressive optic neuropathy (orbit)." ] ] 16 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CNS: central nervous system. MLF: medial longitudinal fasciculus. MS: multiple sclerosis." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Restrictive diplopia (orbit)</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Trauma</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Other muscular alterations:</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Thyroid orbitopathy</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Myositis</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Inflammatory pseudotumor</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Muscular tumors (metastasis)</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Congenital (Brown's syndrome)</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td><td class="td" title="table-entry " colspan="2" align="left" valign="top">Inflammatory (secondary Brown's syndrome)</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Neurological diplopia (cranial pairs)</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">CNS (Nuclei of CN and MLF)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hemorrhage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neoplasm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inflammatory (multiple sclerosis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Nerve (trajectory):</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Congenital</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nerve microvascular ischemia Compression (blood vessel, aneurysm, pathology of cavernous sinus) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tumor – Trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Schwannoma (nerve) Bone tumors (chordoma) Intracranial tumors (meningioma) Intraorbital tumors Most common cranial nerves VI and IV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inflammatory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benign intracranial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Other granulomatous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tolosa Hunt Syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737412.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Causes for diplopia." ] ] 17 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bitemporal hemianopsia (chiasmatic region)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypophyseal adenoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Metastasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Craniopharyingioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pituicytoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Meningioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clivus chordoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chiasm glioma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lymphoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aneurysms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Histiocytosis X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dysgerminoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737418.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Homonymous hemianopsia (retrochiasmatic pathways and occipital cortex)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Infarction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hematoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optic tracts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tumor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral geniculate nucleus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inflammatory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Demyelinating disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Occipital lobe \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Temporal lobe \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737413.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Causes for hemianopsia." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:64 [ 0 => array:3 [ "identificador" => "bib0325" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomía funcional del sistema nervioso central. 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Update in Radiology

Diagnostic imaging in neuro-ophthalmology

Diagnóstico por la imagen en neuroftalmología

A.C. Vela Marín

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acvela@salud.aragon.es

Corresponding author.

, P. Seral Moral, C. Bernal Lafuente, B. Izquierdo Hernández

Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain

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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Orbital trauma&#46; Axial slice with bone window &#40;a&#41; and sagittal reformatting with soft tissue algorithm &#40;b and c&#41; in a 26-year-old woman with facial trauma after a recent traffic accident&#46; She had multiple fractures in her left maxillary sinus and orbit&#44; with multi-fragmented fracture in her orbital roof&#44; revealing one fragment &#40;arrow&#41; in the optic foramen that caused an irreversible lesion of the optic nerve despite urgent treatment&#46; Orbital trauma&#46; Axial slice &#40;d&#41; and sagittal reformatting &#40;e&#41; of CT scan performed on an 80-year-old woman after falling down the stairs&#44; with periorbital hematoma and limitation of ocular motility&#46; Thickening and fraying of retrobulbar and perineural fat compatible with hematoma&#44; which was immediately drained&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The pathology of optic pathways and the orbital structures varies widely&#44; but it has little global incidence&#44; therefore its study and assessment represent a small volume of cases in a radiologist&#39;s standard practice&#44; making it a not very well-known condition and&#44; at times&#44; difficult to manage&#46; That is why it is useful to review the anatomy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; expose which are the imaging modalities suitable for its evaluation and make the right differential diagnosis based on the symptoms&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Visual pathways</span><p id="par0010" class="elsevierStylePara elsevierViewall">There are photoreceptors&#44; cones and rods in the retina in charge of making the synapses with the first neurons or bipolar cells&#44; and in turn these make second synapses with ganglion cells&#44; whose axons make up the optic nerve fibers&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">1</span></a> The nasal hemiretina receives information from the temporal visual field&#44; and the temporal information is received from the nasal visual field&#46; There also occurs a superior&#8211;inferior crossing&#44; so that the information from the superior visual field is collected by the inferior hemiretinas&#44; and vice versa&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;2</span></a> The optical nerve runs through the orbit and into the skull via the optic foramen&#46; It is surrounded by meningeal layers in continuity with the intracranial meninges and by cerebrospinal fluid&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The intracranial segments of both optic nerves converge forming the optic chiasm&#46; The temporal fibers of each retina &#40;nasal visual fields&#41; remain on the same side &#40;homolateral&#41;&#44; and the medial ones &#40;temporal visual fields&#41; decussate toward the contralateral side&#46; Only one half the macular fibers decussate&#59; the rest remain on the homonymous side&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The optic tracts start from the chiasm and&#44; surrounding the mesencephalon&#44; reach the lateral geniculate body&#44; the thalamic nucleus located behind the pulvinar nucleus&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The geniculo-calcarine tracts &#40;optic radiations&#41; connect the lateral geniculate nuclei with the visual cortex&#46; The superior axons relay information from the inferior visual fields&#44; run lateral to the atrium and the posterior horn of the lateral ventricle&#44; pass through the parietal white matter and reach the occipital cortex on the calcarine sulcus&#46; Inferior fibers&#44; with information from the superior visual fields&#44; curve antero-laterally&#44; pass through the caudal portion of the internal capsule&#44; continue along the temporal white matter &#40;Meyer&#39;s loop&#41; surrounding the temporal horn of the ventricle&#44; and posteriorly aim at occipital cortex located under the calcarine sulcus<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#44;4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Oculomotor nerves</span><p id="par0030" class="elsevierStylePara elsevierViewall">The nuclei of the common oculomotor nerve or third cranial nerve &#40;CN III&#41; are located in the periaqueductal region of the mesencephalon at the level of the superior quadrigeminal tubercles&#46; A single central nucleus innervates both elevating muscles of the eyelid&#44; the medial and inferior rectus muscles and the inferior oblique muscles are innervated from the homolateral nuclei&#44; and the superior rectus muscles are innervated from the contralateral ones&#46; The nerve leaves the mesencephalon via the interpeduncular cistern&#44; runs through the superior cerebellar and posterior cerebral arteries running through the dural walls of the cavernous sinus&#44; to reach its final destination on its superior edge&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The nucleus of the CN IV &#40;trochlear nerve&#41; is in the mesencephalon&#44; of inferior location to the CN III nucleus&#44; behind the medial longitudinal fasciculus &#40;MLF&#41;&#46; Its fibers decussate in the mesencephalon and innervate the contralateral superior oblique muscle&#46; The nerve emerges to the subarachnoid space at the level of the inferior quadrigeminal tubercles&#44; running anteriorly through the ambient cistern between the mesencephalon and the tentorium&#46; It runs through the dural walls of the cavernous sinus inferiorly to the CN III&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The nucleus of the CN VI &#40;abducens&#41; is located in the dorsal region of the pons&#44; in front of the floor of the fourth ventricle&#44; and adjacent to the MLF&#46; The majority of its fibers innervate the homolateral lateral rectus muscle&#44; but a small group of axons run&#44; via the MLF&#44; to the contralateral nucleus&#44; providing innervation for the lateral rectus on the other side too&#46; The nerve emerges through the inferior side of the pons&#44; ascends behind the clivus&#44; enters the cavernous sinus&#44; and runs inside the venous plexuses&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#8211;6</span></a> After exiting the cavernous sinus&#44; it reaches the orbit through the sphenoidal fissure&#46; The first and the second branches of the trigeminal nerve also pierce the dural walls of the cavernous sinus&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The MLF runs along the anterior side of the mesencephalic aqueduct up to the anterior cord of the spinal cord&#46; It is made up of association fibers that connect the motor nuclei of the homolateral CN III&#44; IV&#44; VI and XI&#44; and each CN VI with the contralateral CN III&#46; This structure is essential to coordinate the horizontal conjugate gaze&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a> The MLF&#44; the interstitial cells of Cajal and the CN III and IV participate in the coordination of the vertical gaze&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">6&#44;7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Sympathetic and parasympathetic pathways</span><p id="par0050" class="elsevierStylePara elsevierViewall">The Edinger&#8211;Westphal parasympathetic nucleus is located posterior to the CN III nucleus&#46; It is made up of preganglionic parasympathetic neurons whose axons join the CN III fibers on their way toward the orbit&#46; These fibers are in the periphery of the nerve&#46; Inside the orbit they run toward the ciliary ganglion&#44; from which the postganglionic fibers emerge to innervate the constricting muscles of the pupil and the muscle of the ciliary bodies&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The sympathetic pathway is made up of three groups of neurons&#46; The first neuron is located in the hypothalamus and its axons descend to the levels of C8-D2 of the spinal cord&#44; where they meet the second neuron&#46; From that location&#44; the sympathetic pathway ascends to the superior cervical ganglion while running proximal to the carotid bifurcation&#46; The third neuron is in this ganglion and its axons ascend&#44; along with the adventitia of the internal carotid artery&#44; toward the cavernous sinus&#44; joining the first branch of the trigeminal nerve and aiming for the orbit&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#44;4&#44;6&#8211;8</span></a></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Imaging modalities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Simple skull X-ray</span><p id="par0060" class="elsevierStylePara elsevierViewall">The only indication of skull X-rays today is to confirm the presence of intraorbital or intracranial ferromagnetic foreign bodies&#44; whose presence can contraindicate performing a magnetic resonance imaging &#40;MRI&#41; due to risk of mobilization&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Orbital ultrasound</span><p id="par0065" class="elsevierStylePara elsevierViewall">Ultrasound performed with high frequency transducers&#44; 7<span class="elsevierStyleHsp" style=""></span>mHz or more&#8212;it is the modality of choice to assess the ocular globe&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">9&#8211;12</span></a> The globe is examined correctly through ophthalmoscopy&#44; but in the presence of cataracts&#44; vitreous hemorrhages&#44; etc&#46;&#44; which prevent seeing through&#44; ultrasound can be of great help&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">11&#44;13</span></a> It is especially useful in pediatrics&#44; since it does not require sedation and can be used in the evolutionary control of the response to the treatment of some tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">11&#44;13</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Doppler is useful in the assessment of alterations in flow dynamics and it allows the characterization of some vascular lesions&#46; It can be used in the non-invasive assessment of carotid-cavernous fistulas&#44; in which it is possible to observe thickening of an ophthalmic vein with inversion of flow direction and arterializations thereof &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#59; it is useful for both the diagnosis prior to arteriography and the follow-up of those with low flow in which a decision is made not to intervene&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Computed tomography and magnetic resonance imaging</span><p id="par0075" class="elsevierStylePara elsevierViewall">They are the main imaging modalities for orbital and intracranial study&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Computed tomography &#40;CT&#41; provides more information on the bony walls of the orbit&#44; it visualizes calcifications clearly and it is the imaging modality of choice in the presence of ferromagnetic intraorbital foreign bodies that contraindicate the use of MRI&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">15</span></a> Since it is fast and is widely available&#44; it is the modality indicated in emergency contexts&#46; The sequential study of the skull provides the necessary information in cases of urgent vascular and traumatic encephalic pathology&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">16</span></a> Acquisition on multi-slice CT machines with reformatting on the coronal and sagittal planes allows a comprehensive assessment of facial and orbital traumatic lesions&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">MRI provides greater anatomic resolution and better tissue characterization&#44; and good assessment of the signal differences among the different tissues&#59; therefore&#44; it is of choice in orbital studies&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">17</span></a> If it cannot be conducted&#44; it can be replaced by the CT scan with sufficient diagnostic guarantees on most occasions&#46; It can be conducted with skull or surface antennas<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">17</span></a>&#59; the latter provide better signal&#47;noise relation&#44; providing excellent anatomic details of the ocular globe during the examination&#44; yet they are not enough to assess the orbital apex and the intracranial spread of the lesions&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The correct assessment of the hypothalamus-hypophyseal region as well as the study of brain structures should be conducted through an MRI&#46; The protocols will depend on the anatomical area studied&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">18</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Cranial CT-angiography or MRI are indicated in cases of suspicion of aneurysms or vascular malformations&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the CT and MRI study protocols used in our center&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Arteriography</span><p id="par0105" class="elsevierStylePara elsevierViewall">Arteriography maintains its indication in selected cases of aneurysms&#44; carotid-cavernous fistulas&#44; varices or vascular malformations that require diagnostic confirmation and therapeutic procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">19</span></a> In highly vascularized orbital and intracranial tumors its partial embolization can prove beneficial prior to surgery&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Clinical indications of imaging modalities</span><p id="par0110" class="elsevierStylePara elsevierViewall">The first neurophthalmological goal is the clinical location of the lesion&#46; The different symptomatology allows locating the origin of the pathology in each anatomic region and choosing the right imaging modality&#59; it is possible to make a generic division of the ocular globe&#44; orbit&#44; parasellar region&#44; middle cranial fossa and posterior cranial fossa&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> indicates the most appropriate imaging modalities to be used in each region&#46; On many occasions&#44; the use of one modality does not exclude the others&#44; and findings often complement one another to be able to reach diagnosis&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pathology of the ocular globe</span><p id="par0115" class="elsevierStylePara elsevierViewall">Doppler ultrasound is the best screening technique of ocular globe pathology&#44; indicated to differentiate retinal detachment from vitreous hemorrhages&#44; which are sometimes hard to assess through ophthalmoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">11&#44;20</span></a> It is simple and easy to manage when trying to find foreign bodies&#44; although extreme caution should be exercised if ocular globe rupture is suspected&#44; since pressure on the ocular globe with the transducer could cause the extrusion of its content&#46; In these cases&#44; it is better to perform a CT-scan&#44;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">10&#44;12&#44;20</span></a> that also allows us to assess&#44; with high sensitivity&#44; foreign bodies of different materials as well as the condition of the remaining orbital structures&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Ultrasound provides higher spatial resolution than MRI when looking for small ocular tumors&#44; but the MRI is more precise for the assessment of sclerotic infiltration and retrobulbar tumor spread&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">12&#44;21</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The most common intraocular tumor in pediatric age is retinoblastoma &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; whose characteristic clinical sign is leukocoria&#46; Calcifications are present in up to 90&#8211;95 per cent of retinoblastomas&#44;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">13&#44;22&#44;23</span></a> in general in the posterior portion of the globe&#46; Both the ultrasound and the CT scan are highly sensitive to detect them&#44; identifying calcifications of 2 or more mm in thickness&#46; However&#44; the MRI shows better the tumor characteristics&#44; the retrobulbar infiltration and the spread of the disease to the central nervous system&#44; as well as the presence of associated pineal or suprasellar retinoblastomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">22&#44;24</span></a> Today&#44; despite its high sensitivity&#44; the orbital CT scan is not adviseable considering the high radiation that it would mean for the orbit of pediatric patients&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">24</span></a> There are studies that show that the combination of ophthalmoscopy&#44; ultrasound and MRI manages to detect calcifications with the same percentage as CT-scan&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">23</span></a> The most sensitive MRI sequence for the detection of calcifications is the T2-weighted sequence&#42;&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">23</span></a> Recent research supports the utility of diffusion sequences in the diagnosis of retinoblastomas&#44; since they show greater restriction to diffusion than other ocular lesions&#44; and also allow us to monitor the response to treatment by differentiating viable tumor tissue from necrotic tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">25&#44;26</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Choroidal melanoma as primary tumor &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; and metastasis &#40;breast and lung&#44; mainly&#41; are the most common ocular tumors in the adult population&#44;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">10&#44;11&#44;27&#44;28</span></a> but other lesions can appear&#44; such as hemangiomas&#44; hemangioblastomas or granulomatous lesions&#46; The ultrasound is very sensitive for the detection of small tumors&#44; but the MRI is the modality of choice for its study&#44; since it contributes some characteristic details and allows assessing whether there is extraocular spread&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">On the ultrasounds&#44; melanomas look hypoechogenic with the sign of choroidal excavation&#44; characteristic &#40;though not always present&#41; and indicative of local invasion&#46; By applying Doppler&#44; they show high vascularization&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">10&#44;27</span></a> Metastases are hyperechogenic&#44; with greater vascularization in the Doppler study&#44; and they can be multiple&#46; The most significant characteristic of melanomas on the MRI is hyperintensity on T1 and hypointensity on T2&#44; due to its melanin content&#58; the more melanin content&#44; the higher the signal intensity is on the T1-weighted image&#44; and according to some authors&#44; this leads to worse prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">17</span></a> Amelanotic melanomas do not show hyperintensity on T1&#44; which makes it hard to make a differential diagnosis with other tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">29</span></a> Metastases are not visualized as hyperintense on T1 unless there is a hemorrhagic component or high mucoid content inside them&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">27</span></a> Research conducted with diffusion shows great diffusion restriction&#44; with a reduced apparent diffusion coefficient in melanomas with respect to other lesions&#46; Since today the treatment of choice is radiosurgery&#44; monitoring the apparent diffusion coefficient in serial studies allows us to assess how the response to treatment really is&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">30</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The presence of drusen in the optic nerve head can cause elevation of the papilla and blurring of its edges&#44; and on the ophthalmoscopy it can be mistaken for papillary edema&#46; Both on the ultrasound and the CT scan&#44; asymmetrical bilateral or unilateral calcified nodules can be observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">11&#44;12&#44;20</span></a></p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Optic neuritis</span><p id="par0145" class="elsevierStylePara elsevierViewall">Optic neuritis is a clinical diagnosis that leads to the unilateral loss of vision&#44; pain&#44; afferent pupillary defect and campimetric defect&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">7</span></a> Imaging tests of the optic nerve should be conducted whenever there is indication of optic neuritis that cannot be explained by glaucoma&#44; ischemia or toxic&#44; metabolic&#44; infectious or hereditary causes&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">31</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Since optic neuritis can be the initial manifestation in 15&#8211;25 per cent of the patients with multiple sclerosis&#44; and up to 75 per cent of these patients will have at least one episode of optic neuritis&#44; the cranial MRI is recommended in young patients with acute retrobulbar optic neuritis who do not show the above mentioned etiologic factors&#44; seeking lesions typical of demyelinating disease&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">31</span></a> Brain MRI is the best isolated test to assess risk of future multiple sclerosis and help in the decision of prescribing immunomodulatory therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">32&#44;33</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The risk of developing the disease is up to 38 per cent at 10 years and 50 per cent at 15 years in patients with hyperintense lesions on the MRI&#46;<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">31&#44;33&#44;34</span></a> The risk of developing the disease with a normal MRI is much less&#44; 22 per cent at 10 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">32&#44;34</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Compressive optic neuropathy</span><p id="par0160" class="elsevierStylePara elsevierViewall">It usually starts with slow and progressive loss of vision&#46; It can be due to thyroid ophthalmopathy due to intraorbital space involvement&#44; to the compression of the optic nerve fibers due to tumor or infiltrative causes of the nerve itself&#44; or to lesions occupying the intraconal space<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">4&#44;7&#44;35&#44;36</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Increase of intracranial pressure&#44; whether tumor or idiopathic&#44; causes an increase of the cerebrospinal fluid in the optic nerve sheath and the compression of its fibers with vision alterations&#46;<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">37&#44;38</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Damage is generally unilateral&#44; with loss of the monocular visual field&#44; except in the thyroid ophthalmopathy and cranial hypertension&#44; where it is usually bilateral&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">35</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Traumas can cause acute decrease of vision due to an optic nerve lesion of a direct cause&#44; avulsion of the optic nerve itself&#44; laceration by bony fragments&#44; compression&#44; or intraorbital hematomas in the nerve sheath<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">39</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Brain contusions in the frontal lobes can also damage the optic nerves in their intracranial trajectory&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">35</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">The MRI is the modality of choice for the assessment of the orbit&#44; due to its greater capacity to discriminate soft tissues&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">17&#44;40</span></a> The T1-weighted sequence is essential&#44; since most orbital lesions are hypointense with respect to fat&#44; which allows the adequate assessment of their edges&#46; T2 and T1 sequences with gadolinium&#44; with or without fat suppression&#44; provide differentiating data about some tumors &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">Diffusion sequences can help differentiate some orbital tumors&#46; Some studies have proven that optic nerve gliomas show apparent diffusion coefficient values that are significantly lower than meningiomas&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">17</span></a> Also&#44; lymphoproliferative diseases &#40;lymphoma&#41; cause greater diffusion restriction than inflammatory diseases &#40;inflammatory pseudotumor&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">41&#44;42</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The CT scan is more useful for the assessment of bony alterations&#44; being the modality of choice in orbital traumas and for the detection of calcifications &#40;present in up to 33 per cent of nerve sheath meningiomas&#41;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">17</span></a> or phleboliths in cavernous hemangiomas and lymphangiomas&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The presence of bilateral papilledema requires an urgent CT scan in order to seek intracranial massess or hydrocephaly as causes of the cranial hypertension&#46; In the absence of findings&#44; the angio-CT can be indicated to rule out thrombosis of the venous sinus&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">7&#44;43</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Diplopia</span><p id="par0200" class="elsevierStylePara elsevierViewall">Binocular diplopia occurs as a result of misalignment of the visual axes&#44; resulting in the images coming from each eye not fusing in the brain and thus originating double vision&#46; It can have a restrictive cause and then the lesion is located in the orbit&#44; or a nervous cause with the lesion located in the CN nuclei or their trajectory&#44; whether due to nerve intrinsic pathology or compression in its trajectory through the basal cisterns<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">44&#44;45</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Restrictive diplopia</span><p id="par0205" class="elsevierStylePara elsevierViewall">Thyroid ophthalmopathy and traumas are the most common causes of restrictive diplopia&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Thyroid ophthalmopathy &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41; starts with extraocular muscle enlargement&#44; usually bilateral&#44; but asymmetrical&#46; The muscles most commonly affected are the internal and inferior rectus muscles&#44; and more rarely the lateral rectus muscle&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">36&#44;45</span></a></p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">The orbital CT scan is included in most thyroid ophthalmopathy diagnostic protocols&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">36&#44;46</span></a> Axial slices assess the degree of exophthalmos and the increase of orbital fat&#59; coronal slices are essential to compare the volume of homonymous muscles in both eyes and their size variations in serial controls&#44; as well as to monitor the response to treatment&#46; The CT scan makes adequate assessments of the orbital walls before planning decompressive surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">36&#44;40&#44;46</span></a> The administration of iodinated contrast is not useful and should be avoided&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">16&#44;47</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">The MRI allows us to differentiate the acute from the chronic stages of the disease&#46; In the acute stage&#44; muscular edema causes hypersignal on the T2-weighted sequences with fat suppression and STIR&#44; and in the fibrosis stage&#44; the muscles are hypointense in T1 and T2&#44; with hyperintense foci in T1&#44; representative of fat infiltration&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">40&#44;46</span></a> A good correlation between the signal pattern in T2 and the reversibility of diplopia has been described&#44; when seeing how the cases with homogeneous hypersignal show better responses to treatment than whenever the signal is hypointense and heterogeneous&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">48</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Orbital wall fractures&#44; especially those on the orbital floor or the lamina papyracea &#40;blow-out&#41;&#44; can cause ocular movements restriction&#44; and therefore diplopia due to edema or hemorrhages in the orbital fat that pulls from the muscle&#44; also muscle swelling or herniation of the muscular center through the fracture &#40;in general of the inferior rectus&#41;&#46; This is why it is crucial to assess the condition of the extraocular muscles in the CT scans of patients with facial traumas&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">49</span></a> The coronal plane provides more information for the detection of muscle herniations &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41; and it is essential when making the decision of conducting urgent or delayed surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">50&#44;51</span></a></p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><p id="par0230" class="elsevierStylePara elsevierViewall">Other damage to the extraocular muscle can cause movement restriction and diplopia&#46; The differentiation is based mainly on the morphological assessment of the lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Nervous diplopia</span><p id="par0235" class="elsevierStylePara elsevierViewall">Diplopia due to paralysis of a CN can be due to ischemia in the vasculature of the nerve itself or to small infarctions in the mesencephalic nuclei&#44; due to trauma&#44; aneurysms in the circle of Willis arteries or neoplasms that can compress the nerves along their trajectory&#46;<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">45&#44;52&#8211;54</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The isolated paralyzes of some CN in patients over 50 years old with a history of diabetes&#44; high blood pressure or vascular diseases are usually of microvascular origin and there is no need to conduct imaging modalities&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">43&#44;53&#44;55&#8211;57</span></a> They are usually resolved completely in less than 3 months&#46; If they are not resolved or if we are dealing with a young patient without vascular risk factors&#44; neuroradiological tests are indicated&#44; being the MRI the modality of choice<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">58</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>a&#8211;c&#41;&#46; In such case&#44; it would be good to administer contrast&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">43</span></a></p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall">CN IV&#44; due to its length&#44; and CN VI&#44; due to its ascending trajectory posterior to the clivus&#44; are vulnerable to cranial traumas&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">43&#44;45&#44;54</span></a> Bilateral damage to the CN VI can be due to cranial hypertension or tumor-related compression&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">43&#44;53</span></a> The initial imaging modality is the CT scan&#44; since these patients are usually under urgent examination&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The complete paralysis of the CN III is associated to pupillary dysfunction or incomplete paralysis with or without pupillary damage&#44; requires conducting an urgent angio-CT scan or angio-MRI to rule out aneurysm&#44; usually located in the junction between the posterior communicating artery and the internal carotid artery&#46;<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">55&#44;56&#44;59</span></a> The angio-CT scan&#44; due to its greater availability in the ER context is the most commonly used modality &#40;<a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a>&#41;&#46; The intracavernous internal carotid artery aneurysm commonly causes CN VI paralysis due to its proximity within the cavernous sinus&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">60</span></a></p><elsevierMultimedia ident="fig0050"></elsevierMultimedia><p id="par0255" class="elsevierStylePara elsevierViewall">Neoplasms&#44; severe cranial traumas&#44; or large aneurysms can cause damage to several CNs&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">54</span></a> Conducting either a CT scan or an MRI will depend on their availability within the patient&#39;s clinical context&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">The cavernous sinus diseases &#40;carotid-cavernous fistula&#44; dural fistula&#44; thrombosis&#41; can cause damage to several CNs or CN VI along with the sympathetic pathway&#44; due to their proximity to the internal carotid artery&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#44;5&#44;45</span></a> The MRI is the most suitable modality for its study&#46; The Tolosa&#8211;Hunt syndrome &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>d&#8211;f&#41; is a clinical diagnosis consisting of orbital pain with homolateral ophthalmoplegia &#40;more frequently CN III&#44; followed by CN IV and VI&#41; that affects the cavernous sinus and can spread toward the orbital apex&#46;<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">60&#44;61</span></a> On the MRI it is possible to observe cavernous sinus thickening&#44; bulging of its lateral edge&#44; and intense enhancement after the administration of gadolinium&#46; Corticoid therapy leads to clinical and radiological improvement&#46; There are times that the findings can be subtle&#46; To make sure that its diagnosis is accurate&#44; other cavernous sinus damage causes should be ruled out here&#46;<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">62</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">Internuclear ophthalmoplegia consists of the loss or limitation of adduction in one eye and horizontal nystagmus during the abduction of the other eye&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">6</span></a> The MRI shows the lesions in MLF location&#44; being the most common causes multiple sclerosis in young people and ischemia in the elderly&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">4&#44;6</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Bitemporal campimetric defects</span><p id="par0270" class="elsevierStylePara elsevierViewall">In the bitemporal campimetric defects&#44; the pathology is in the chiasmatic region&#44; where the decussation of the nasal fibers is consistent with temporal hemiretinas&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Tumors in the sellar and parasellar region &#40;<a class="elsevierStyleCrossRef" href="#fig0055">Fig&#46; 11</a>&#41;&#44; among them&#44; the hypophyseal adenoma being the most common can compress the optic chiasm &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; Chiasm gliomas themselves can cause asymmetric bitemporal campimetric defects depending on the fibers damaged&#46; Intrasellar lesions affect the superior temporal fields&#44; and hypothalamic lesions or those of the third ventricle region damage the inferior ones&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0055"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0280" class="elsevierStylePara elsevierViewall">The modality of choice for its assessment is the MRI focused on the hypothalamus-hypophysis region&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Homonymous hemianopsia</span><p id="par0285" class="elsevierStylePara elsevierViewall">The homonymous defects of the visual field involve lesions of the retrochiasmatic visual pathway<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">3</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; If hemianopsia is congruent&#44; the lesion will be found in the occipital cortex or close to it&#44; if it is not&#44; the lesion should be looked for in the optic tracts&#44; the lateral geniculate ganglion or Meyer&#39;s loop&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">7</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">Cerebral vascular accidents are the most common cause of isolated homonymous hemianopsias<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">63</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0060">Fig&#46; 12</a>&#41;&#46; These defects should always be studied radiologically&#44; except when they are clearly associated with an old cerebral vascular accident&#46; Given that strokes have an acute clinical presentation&#44; the cranial CT scan is the initial modality to assess these cases&#44; especially if hemorrhage is suspected&#46; When the cause is thought not to be vascular &#40;tumors&#44; demyelinating disease&#44; etc&#46;&#41;&#44; the cranial MRI provides more information to be able to reach the correct diagnosis&#46;</p><elsevierMultimedia ident="fig0060"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Horner&#39;s syndrome</span><p id="par0295" class="elsevierStylePara elsevierViewall">Damage to the sympathetic pathway occurs with mild ptosis&#44; miosis and&#44; at times&#44; anhidrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#44;4</span></a> On suspicion that the first neuron is affected with cerebral symptoms&#44; both an MRI and a brain angio-MRI should be conducted&#44; and in the absence of brain symptoms&#44; a cervical MRI should the modality of choice&#46; In the former case we could find ischemic&#44; inflammatory or tumor lesions in the hypothalamic region and&#44; if there is medullary damage&#44; we can find syringohydromyelia or medullary neoplasms&#46; To study the pathology that affects the preganglionic neurons&#44; one CT scan of the neck&#44; including the cervicothoracic junction&#44; is more suitable&#44; since it is possible to find tumors of the pulmonary apex&#44; endothoracic goiter&#44; schwannomas&#44; or neuroblastic tumors&#44; and in cases where there is damage to the postganglionic neurons&#44; the CT scan or the MRI should be conducted including vascular sequences in order to rule out arterial pathology&#44; such as carotid dissection or lesions in the sellar and parasellar regions&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">8&#44;64</span></a></p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0300" class="elsevierStylePara elsevierViewall">Knowledge of the optic pathway anatomy&#44; the CNs and the autonomous pathways involved in the motility and correct clinical information are crucial to be able to select and plan radiological examinations&#46; The classification of the pathology based on the most relevant clinical sign or symptom in each case will allow us to select the most suitable imaging modality&#44; while taking into account the most common differential diagnoses in each group of patients&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors&#8217; contributions</span><p id="par0305" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study&#58; ACVM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Study Idea&#58; ACVM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Study Design&#58; ACVM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0325" class="elsevierStylePara elsevierViewall">Data Mining&#58; ACVM&#44; PSM&#44; CBL and BIH&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0330" class="elsevierStylePara elsevierViewall">Data Analysis and Interpretation&#58; ACVM&#44; PSM&#44; CBL and BIH&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0335" class="elsevierStylePara elsevierViewall">Statistical analyses N&#47;A&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0340" class="elsevierStylePara elsevierViewall">Reference&#58; ACVM&#44; PSM&#44; CBL and BIH&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0345" class="elsevierStylePara elsevierViewall">Writing&#58; ACVM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0350" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks&#58; ACVM&#44; PSM&#44; CBL and BIH&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0355" class="elsevierStylePara elsevierViewall">Approval of final version&#58; ACVM&#44; PSM&#44; CBL and BIH&#46;</p></li></ul></p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0360" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever&#46;</p></span></span>"
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          "titulo" => "Introduction"
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              "titulo" => "Visual pathways"
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            3 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Arteriography"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Clinical indications of imaging modalities"
        ]
        7 => array:3 [
          "identificador" => "sec0055"
          "titulo" => "Pathology of the ocular globe"
          "secciones" => array:8 [
            0 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Optic neuritis"
            ]
            1 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Compressive optic neuropathy"
            ]
            2 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Diplopia"
            ]
            3 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Restrictive diplopia"
            ]
            4 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Nervous diplopia"
            ]
            5 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Bitemporal campimetric defects"
            ]
            6 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Homonymous hemianopsia"
            ]
            7 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Horner&#39;s syndrome"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Authors&#8217; contributions"
        ]
        10 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:2 [
          "identificador" => "xack345205"
          "titulo" => "Acknowledgements"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-01-02"
    "fechaAceptado" => "2017-11-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec980500"
          "palabras" => array:4 [
            0 => "Orbit"
            1 => "Visual pathways"
            2 => "Ophthalmologic imaging techniques"
            3 => "Ocular diseases"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec980499"
          "palabras" => array:4 [
            0 => "&#211;rbita"
            1 => "V&#237;as visuales"
            2 => "T&#233;cnicas de imagen oftalmol&#243;gicas"
            3 => "Enfermedades oculares"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Neuro-ophthalmology is a field combining neurology and ophthalmology that studies diseases that affect the visual system and the mechanisms that control eye movement and pupil function&#46; Imaging tests make it possible to thoroughly assess the relevant anatomy and disease of the structures that make up the visual pathway&#44; the nerves that control eye and pupil movement&#44; and the orbital structures themselves&#46; This article is divided into three sections &#40;review of the anatomy&#44; appropriate imaging techniques&#44; and evaluation of disease according to clinical symptoms&#41;&#44; with the aim of providing useful tools that will enable radiologists to choose the best imaging technique for the differential diagnosis of patients&#8217; problems to reach the correct diagnosis of their disease&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La neuroftalmolog&#237;a es la parte de la neurolog&#237;a y la oftalmolog&#237;a que se encarga del estudio de las enfermedades que afectan al sistema visual y a los mecanismos que controlan la motilidad ocular y la funci&#243;n pupilar&#46; Las pruebas de imagen permiten realizar una adecuada valoraci&#243;n anat&#243;mica y patol&#243;gica de las estructuras que conforman la v&#237;a visual&#44; los nervios que controlan la motilidad ocular y pupilar&#44; y las propias estructuras orbitarias&#46; Este art&#237;culo se divide en tres apartados &#40;recuerdo anat&#243;mico&#44; t&#233;cnicas de imagen apropiadas y valoraci&#243;n patol&#243;gica en funci&#243;n de la sintomatolog&#237;a cl&#237;nica&#41; con el prop&#243;sito de proporcionar herramientas &#250;tiles que permitan al radi&#243;logo elegir en cada momento la t&#233;cnica de imagen m&#225;s adecuada para el correcto diagn&#243;stico de las enfermedades y un ajustado diagn&#243;stico diferencial&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; Vela Mar&#237;n AC&#44; Seral Moral P&#44; Bernal Lafuente C&#44; Izquierdo Hern&#225;ndez B&#46; Diagn&#243;stico por la imagen en neuroftalmolog&#237;a&#46; Radiolog&#237;a&#46; 2018&#59;60&#58;190&#8211;207&#46;</p>"
      ]
    ]
    "multimedia" => array:18 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Drawing representing the optic pathways&#46; &#40;b&#41; Drawing showing the location of the nuclei of the oculomotor cranial pairs relative to the mesencephalon and the pons&#46; &#40;c&#41; Schematic drawing of the correlations of the cranial pairs with the cavernous sinus and the intracavernous internal carotid artery&#46; a&#58; Retina&#59; b&#58; optic nerve&#59; c&#58; optic chiasm&#59; d&#58; optic tract&#59; e&#58; lateral geniculate ganglion&#59; f&#58; inferior geniculocalcarine tracts or Meyer&#39;s loop&#59; g&#58; superior geniculocalcarine tracts&#59; h&#58; occipital cortex&#59; II&#58; optic nerve&#59; III&#58; common oculomotor nerve&#59; IV&#58; trochlear nerve&#59; VI&#58; abducens nerve&#59; V1&#58; first branch of the trigeminal nerve&#59; V2&#58; second branch of the trigeminal nerve&#46;</p>"
        ]
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Carotid-cavernous fistula&#46; Forty-eight-year-old woman who&#44; after falling down the stairs&#44; presents with progressive left exophthalmos and palpebral swelling&#46; The Color Doppler ultrasound &#40;a and b&#41; shows the thickening of the superior ophthalmic vein with arterialized flow&#46; Coronal &#40;c&#41; and axial &#40;d&#41; slices of orbital CT scan without contrast showing thickening of the left extraocular muscles due to congestive edema and thickening of the superior ophthalmic vein &#40;arrow&#41;&#59; compare with the contralateral one&#46; Arteriographic confirmation was made and treatment administered through embolization with no success&#44; and later closure of carotid above and below the fistula&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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            "Ancho" => 2000
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Retinoblastoma&#46; Ocular ultrasound &#40;a&#41; and T2 axial slice with fat saturation &#40;b&#41; in a two-month-old infant with leukocoria&#46; The ultrasound shows one lobulated&#44; heterogeneous mass&#44; with hyper-refringent images indicative of calcifications&#46; The T2 the image is highly hypointense&#46; Both modalities rule out retrobulbar invasion&#46; Bilateral retinoblastoma&#46; T2 axial slices with fat saturation &#40;c&#41; and T1 with fat saturation with gadolinium &#40;d&#41; in a nine-month-old infant with right leukocoria&#46; Right intraocular lesion hypointense in T2 with homogeneous enhancement after the administration of gadolinium&#44; that produces retinal detachment without invasion of retrobulbar structures&#46; It is possible to observe a small image in the left ocular globe with similar characteristics in the nasal region &#40;arrow&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
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            "Alto" => 1493
            "Ancho" => 2000
            "Tamanyo" => 285136
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Melanoma&#46; Ocular ultrasound &#40;a&#41; and T2 axial slice with fat saturation &#40;b&#41; in a 58-year-old male who presented to the ER with blurry vision&#46; Ophthalmoscopy revealed one slightly pigmented&#44; elevated peripapillary mass&#46; The ultrasound reveals one small lenticular mass with the choroidal excavation sign &#40;arrows&#41;&#44; and the T2 MRI slice shows the hypointense lesion adjacent to the papilla&#46; Melanoma&#46; T1 &#40;c&#41; and T2 axial slices with fat saturation &#40;d&#41; of a 73-year-old patient with one prominent mass in the lower quadrants revealed by the ophthalmoscopy&#46; On the MRI&#44; the lesion shows the characteristics typical of melanomas&#44; hyperintense in T1 and hypointense in T2&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1894
            "Ancho" => 2500
            "Tamanyo" => 335579
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Orbital trauma&#46; Axial slice with bone window &#40;a&#41; and sagittal reformatting with soft tissue algorithm &#40;b and c&#41; in a 26-year-old woman with facial trauma after a recent traffic accident&#46; She had multiple fractures in her left maxillary sinus and orbit&#44; with multi-fragmented fracture in her orbital roof&#44; revealing one fragment &#40;arrow&#41; in the optic foramen that caused an irreversible lesion of the optic nerve despite urgent treatment&#46; Orbital trauma&#46; Axial slice &#40;d&#41; and sagittal reformatting &#40;e&#41; of CT scan performed on an 80-year-old woman after falling down the stairs&#44; with periorbital hematoma and limitation of ocular motility&#46; Thickening and fraying of retrobulbar and perineural fat compatible with hematoma&#44; which was immediately drained&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 1629
            "Ancho" => 2667
            "Tamanyo" => 434583
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Optic nerve glioma&#46; T2 axial slices with fat saturation &#40;a&#41; and T1 with fat saturation with gadolinium &#40;b&#41; in a patient with reduced visual acuity and papillary edema&#46; Fusiform thickening of the right optic nerve that impacts on the papilla&#44; hyperintense in T2 with homogeneous enhancement after contrast administration&#46; Optic nerve sheath meningioma&#46; T1 axial slice with fat saturation &#40;c&#41; with gadolinium and T1 sagittal slice with fat saturation &#40;d&#41; in a young man with slow&#44; progressive loss of vision and signs of severe left neuropathy in evoked potentials&#46; Tubular thickening of the left optic nerve sheath that surrounds and constricts the nerve and enhances intensely with gadolinium&#44; spreading through the orbital foramen to the middle cranial fossa &#40;arrow&#41;&#46; Venolymphatic malformation&#46; T2 axial slices with fat saturation &#40;e&#41; and T1 &#40;f&#41; in a 2-year-old girl with right ocular proptosis&#46; Right orbital mass with intraconal and extraconal component&#44; with cystic images and fluid&#47;fluid levels due to the hemorrhagic component of the cysts&#46; Cavernous vascular malformation&#46; T2 axial slice with fat saturation &#40;g&#41; and T1 sagittal slice with fat saturation with gadolinium &#40;h&#41; in a 60-year-old patient with reduced visual acuity in his left eye&#46; Rounded&#44; well-established mass in the orbital apex&#44; hyperintense in T2 and intensely enhanced in the slice with contrast that compresses the optic nerve&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1901
            "Ancho" => 2000
            "Tamanyo" => 333592
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Thyroid orbitopathy&#46; Coronal &#40;a and b&#41; and axial slices &#40;c and d&#41; of CT scan without contrast in a 43-year-old woman with hyperthyroidism&#46; Fusiform thickening of the bilateral and asymmetric extraocular muscles&#44; especially of the inferior recti and&#44; to a lesser extent&#44; of the left medial and right lateral rectus&#46; We can also see the inflammatory infiltration of intraconal fat&#46; T1 and T2 axial slices with fat saturation &#40;e and f&#41; and T1 orbital and coronal slices with gadolinium of hypophysis &#40;g&#41; in a patient with hyperthyroidism&#46; Fusiform thickening of left internal rectus muscle with hypersignal in T2 sequence with fat saturation&#44; hypersignal that is also observed in the right medial rectus&#44; indicative of the acute stage of the disease&#46; As an incidental finding&#44; there is one hypophyseal macroadenoma that superiorly displaces the chiasm&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1635
            "Ancho" => 2000
            "Tamanyo" => 275825
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Blow-out fracture of lamina papyracea with muscle herniation&#46; Axial &#40;a&#41; and coronal &#40;b&#41; CT slices and T1coronal slices &#40;c and d&#41; in a 13-year-old girl who&#44; after suffering a head trauma following run over accident&#44; presents complete adduction and partial abduction deficits in her left eye with diplopia&#46; The CT slices show the fracture line in the lamina papyracea&#44; occupation of the middle ethmoidal cell&#44; and irregular morphology of the internal rectus muscle on her left side&#46; The MRI slices show the change in shape and orientation of the internal rectus muscle with respect to the contralateral one&#44; with &#8220;bow-tie&#8221; morphology due to muscle herniation in the ethmoidal cell&#46;</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "fig0045"
        "etiqueta" => "Figure 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr9.jpeg"
            "Alto" => 1801
            "Ancho" => 2533
            "Tamanyo" => 411034
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient with multiple sclerosis&#46; DP &#40;a&#41;&#44; FLAIR &#40;b&#41; and FLAIR &#40;c&#41; axial slices in a 27-year-old woman with right cranial nerve VI palsy&#46; The MRI slices show one hyperintense demyelinating plate adjacent to the floor of the fourth ventricle in the location of the cranial nerve VI nucleus&#46; The complete study showed typical periventricular and juxtacortical demyelinating lesions&#46; Tolosa&#8211;Hunt syndrome&#46; Coronal T2 &#40;d&#41;&#44; axial &#40;e&#41; and coronal &#40;f&#41; slices with gadolinium of a patient with headache&#44; left palpebral ptosis&#44; and palsy of the left cranial nerves III and IV&#46; Treatment with corticoids led to a rapid clinical improvement&#46; The MRI slices show thickening of left cavernous sinus&#44; with intense enhancement&#44; spreading toward the orbital apex&#46;</p>"
        ]
      ]
      9 => array:7 [
        "identificador" => "fig0050"
        "etiqueta" => "Figure 10"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr10.jpeg"
            "Alto" => 1857
            "Ancho" => 2533
            "Tamanyo" => 407404
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Aneurysms&#46; Axial &#40;a&#41;&#44; coronal &#40;b&#41; and 3D &#40;c&#41; reformatting of maximum intensity projection of an angio-CT scan conducted in a 50-year-old woman who&#44; after suffering from progressive headache for several weeks&#44; presents to the ER with complete palsy of the right cranial nerve III and mydriatic pupil&#46; Small aneurysm in the junction between the right internal carotid artery and the posterior communicating artery in contact with the cranial nerve III&#46; Axial &#40;d&#41; and coronal &#40;e&#41; MIP reformatting of angio-CT scan and diagnostic arteriography images &#40;f&#41; and after treatment &#40;g&#41; of a 48-year-old patient who presented to the ER with intense&#44; headache of two-day duration with vomits and left cranial nerve VI palsy&#46; One aneurysm is identified in the intracavernous internal carotid artery justifying the compression of the cranial nerve VI&#46; It is confirmed through the arteriography&#44; and the complete closure of the aneurysm is confirmed after the embolization&#46;</p>"
        ]
      ]
      10 => array:7 [
        "identificador" => "fig0055"
        "etiqueta" => "Figure 11"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr11.jpeg"
            "Alto" => 1849
            "Ancho" => 2533
            "Tamanyo" => 422227
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Hypophyseal macroadenoma&#46; T1 coronal &#40;a&#41;&#44; and coronal &#40;b&#41; and T1 sagittal &#40;c&#41; slices with gadolinium&#44; in a 59-year-old patient with bitemporal hemianopsia&#46; Hypophyseal mass with intrasellar and suprasellar component&#44; with &#8220;snowman&#8221; morphology compressing the optic chiasm &#40;arrows&#41;&#46; The macroadenoma shows one hyperintense cystic component in T1 that does not enhance&#44; unlike the rest of the lesion&#46; Craniopharyingioma&#46; T1 sagittal &#40;d&#41; and axial FLAIR &#40;e&#41; and SPGRT1 &#40;T1 spoiled gradient&#41; slices with gadolinium &#40;f&#41;&#44; in a 61-year-old patient with right and left temporal visual field damage&#46; Suprasellar mass with cystic lesion and solid component that enhances with gadolinium&#46; Note that&#44; unlike the macroadenoma&#44; the lesion compresses the chiasm from above&#44; and the hypophysis is compressed on the bottom of the sella turcica &#40;arrow&#41;&#46;</p>"
        ]
      ]
      11 => array:7 [
        "identificador" => "fig0060"
        "etiqueta" => "Figure 12"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr12.jpeg"
            "Alto" => 2101
            "Ancho" => 2000
            "Tamanyo" => 271793
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Acute occipital infarction&#46; Axial FLAIR &#40;a&#41; and diffusion &#40;b&#41; slices in a patient with sudden alteration of vision&#44; and confirmation of right inferior homonymous quadrantanopia&#46; Hyperintense lesion in the left occipital cortex shining in diffusion&#46; The lesion was located above the calcarine sulcus&#46; Acute occipital hemorrhages&#46; CT axial &#40;c&#41; slices in a 75-year-old patient that presents to the ER with headache&#44; vomits and left homonymous hemianopsia&#44; and CT axial &#40;d&#41; slice of the same patient presenting one year later with total blindness&#46; In the first study&#44; the right occipital acute hematoma can be seen&#44; which justifies the presence of left hemianopsia&#46; In the subsequent study&#44; the right occipital encephalomalacia residual to the prior hematoma can be seen plus one new left occipital hematoma that by causing the right hemianopsia is causing total blindness&#46;</p>"
        ]
      ]
      12 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at1"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visual field&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hemiretina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chiasm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tract&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Geniculate ganglion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Optic radiations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Occipital cortex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temporal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contralateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contralateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contralateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contralateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Direct&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Temporal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Homolateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Homolateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Homolateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Homolateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Includes Meyer&#39;s loop&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inferior to the calcarine sulcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Superior to the calcarine sulcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Macula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cross&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both sides of the calcarine sulcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Direct&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Scheme-summary of the direction of the visual pathways&#46;</p>"
        ]
      ]
      13 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CT machine&#58; Toshiba Aquilion 64&#46; Toshiba Medical Systems&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">MRI machine&#58; Signa Excite 1&#46;5&#46; General Electric Healthcare&#46; Milwakee&#46; Wisconsin&#44; USA&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">EPI&#58; echo-planar imaging&#59; Fast SPGR&#58; fast spoiled gradient&#59; FS&#58; fat sat &#40;fat saturation&#41;&#59; MIP&#58; maximum intensity projection&#59; MPR&#58; multiplane reformatting&#59; SE&#58; spin echo&#59; SS coherent&#58; steady state coherent&#59; STIR&#58; short tau inversion recovery&#59; SWI&#58; susceptibility-weighted imaging&#59; T2&#42;&#58; weighted gradient echo in T2&#59; TOF&#58; time of flight&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CT-scan protocol</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sequential CT-scan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Helical CT-scan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Angio-CT-scan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brain structures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orbit and facial structures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerebral and supra-aortic trunks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reconstruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reconstruction&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Slice thickness&#58; 5&#8211;8<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Slice thickness&#58; 0&#46;5&#8211;1<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Slice thickness&#58; 0&#46;5&#8211;1<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Advance&#58; 5<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Interspace&#58; 0&#46;3&#8211;0&#46;8<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Interspace&#58; 0&#46;3&#8211;0&#46;8<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Algorithm&#58; brain and bone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Algorithm&#58; soft tissues and bone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Algorithm&#58; soft tissues and bone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reformatting&#58; axial&#44; sagittal and coronal MPR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reformatting&#58; axial&#44; sagittal and coronal MIP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm every 2<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;7&#8211;10<span class="elsevierStyleHsp" style=""></span>mm every 5&#8211;8<span class="elsevierStyleHsp" style=""></span>mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Administration of contrast&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Administration of contrast&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Administration of contrast&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tumor&#44; infectious or vascular pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumor&#44; infectious or vascular pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>cc high concentration at 5<span class="elsevierStyleHsp" style=""></span>ml&#47;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>cc physiological saline solution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MRI protocol</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cranial MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Orbital MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hypophyseal MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Skull &#40;orbit&#41; or surface &#40;balloon&#41; antenna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axial T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sagittal and coronal T1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FLAIR T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Axial T2FS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sagittal and coronal T1 with gadolinium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diffusion &#40;factor B&#58; 1000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coronal STIR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coronal T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gradient Echo&#58; T2&#42;&#44; SWI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">T1FS with gadolinium &#40;axial&#44; coronal&#44; sagittal&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Slice thickness&#58; 2&#8211;3<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Slice thickness&#58; 2&#8211;3<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Matrix&#58; 256<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>256&#59; 512<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>512&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Matrix&#58; 256<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complementary sequences&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complementary sequences&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complementary sequences&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3D SS Coherent&#58; cranial pairs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dynamic fast SPGR FS&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3DT1 with gadolinium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Angio-MRI 3D TOF&#58; aneurysms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tumors vascular lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">T2 sagittal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3DT1 with gadolinium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diffusion SE&#44; EPI&#44; T2&#42; calcifications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CT scan and MRI protocols in the neuro-ophtalmology unit at the Hospital Universitario Miguel Servet&#44; Zaragoza&#44; Spain&#46;</p>"
        ]
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      14 => array:8 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ocular globe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Choice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ultrasound<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Foreign body&#47;calcifications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT-scan<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Soft tissues&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MRI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Trauma&#44; foreign body&#44;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT-scan<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">bony lesions&#44; calcifications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Graves&#8217; disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Orbit &#40;optic nerve&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exophthalmos&#44; suspicion of tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MRI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT-scan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alteration of flow dynamics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Doppler<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Arteriography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT-scan&#47;MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sellar and parasellar region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MRI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chiasm &#40;hypothalamus-hypophyseal region&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Base of skull&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT-scan<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vascular pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Angio-CT scan&#47;MRI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retrochiasmatic pathways&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MRI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior fossa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CT-scan<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Indications of the imaging modalities in neuro-ophthalmology based on anatomical areas and pathology&#46;</p>"
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        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Thyroid orbitopathy</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Tumor&#47;infiltration of nerve</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tumor&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Optic nerve glioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inflammatory&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Optic nerve sheath meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inflammatory pseudotumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lymphoproliferative syndromes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Intraconal masses</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vascular&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cavernous vascular malformation<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Inflammation&#47;infection</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Venolymphatic malformation<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inflammatory pseudotumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orbital varicose vein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Granulomatous polyangiitis<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High flow arteriovenous malformation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orbital cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tumors&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leukemia&#47;lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orbital abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cranial spread of meningioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Intracranial hypertension</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Traumas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Direct&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Optic nerve avulsion and laceration<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Indirect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Perineural hematoma</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0010"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Also known as cavernous hemangioma&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Also known as cystic lymphangioma&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Formerly known as Wegener&#39;s granulomatosis&#46;</p>"
            ]
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              "identificador" => "tblfn0025"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">It is not cause for compressive optic neuropathy as such&#44; but the lesion includes nervous fiber tears&#46;</p>"
            ]
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Causes for compressive optic neuropathy &#40;orbit&#41;&#46;</p>"
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        "etiqueta" => "Table 5"
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">CNS&#58; central nervous system&#46; MLF&#58; medial longitudinal fasciculus&#46; MS&#58; multiple sclerosis&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Restrictive diplopia &#40;orbit&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Trauma</span></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Other muscular alterations&#58;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Thyroid orbitopathy</span></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Myositis</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Inflammatory pseudotumor</span></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Muscular tumors &#40;metastasis&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Congenital &#40;Brown&#39;s syndrome&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"></td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Inflammatory &#40;secondary Brown&#39;s syndrome&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Neurological diplopia &#40;cranial pairs&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">CNS &#40;Nuclei of CN and MLF&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ischemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hemorrhage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neoplasm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2018.03.004

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