# Neurological and neurosurgical conditions presenting first with ophthalmological clinical features: A case series

## TL;DR

This paper presents four cases where eye symptoms were the first sign of serious neurological or systemic diseases, showing how ophthalmologists can help detect these conditions early.

## Contribution

The paper highlights the importance of ophthalmological evaluation in uncovering underlying neurological and systemic conditions through real-world case examples.

## Key findings

- Ocular symptoms can be the first sign of severe conditions like aneurysms, multiple myeloma, and autoimmune disorders.
- Early detection by ophthalmologists and interdisciplinary collaboration leads to timely and effective treatment.
- Optic neuritis and ptosis can indicate broader neurological disorders such as Neuromyelitis Optica Spectrum Disorder.

## Abstract

We report four unique neurological cases that initially presented with ophthalmological manifestations.

In the first case, a 36-year-old man came in with a left-sided headache and isolated third nerve palsy. Detailed investigations led to the discovery of a supraclinoid internal carotid artery aneurysm, necessitating prompt neurosurgical intervention. The second case featured a 74-year-old man with complete drooping of his right eyelid. The diagnosis of complete third nerve palsy led to further tests, which uncovered multiple myeloma. The third case involved a 19-year-old girl who had persistent double vision and bilateral ptosis. A collaborative effort between ophthalmologists and neurologists revealed Miller Fisher syndrome, which was successfully treated with intravenous immunoglobulins. Lastly, the fourth case described an 8-year-old girl who presented with optic neuritis. A thorough ophthalmological evaluation led to the diagnosis of Neuromyelitis Optica Spectrum Disorder, enabling early treatment and significant improvement.

These cases highlight the crucial role of ophthalmologists in identifying severe systemic and neurological conditions through subtle ocular signs. Each diagnosis—from aneurysms to autoimmune and malignant disorders—was made possible by vigilant ophthalmic evaluation and timely interdisciplinary collaboration. These examples reinforce that the eye often provides the first clue to an underlying disease, and that early recognition by ophthalmologists can be critical to effective, and sometimes lifesaving, intervention.

These cases collectively emphasize the critical importance of detailed ocular evaluation in the early detection and management of a wide range of neurological and systemic conditions, highlighting how ocular symptoms can often be the first indication of more serious underlying health issues.