Case #11 – Non-glaucomatous RNFL loss with Cerebellar Atrophy

References M.E Hajee, W.F March, D.R Lazzaro, A.H Wollintz, E.M Shrier, S. Glazman, and I.G Bodis-Wollner. 2009 Inner Retinal LayerThinning in Parkinson's Disease. Archives of Ophthalmology; 127 (6) 737-741 K. Agan, D. Kutlu, N. Basak, O. Us, and D. ince-Gönal. 2006 Spinocerebellar Ataxia Type 2 In A Turkish Family. Marmara Medical Journal; 19 (3)135-138

Acknowledgements Jeremy Whitney Sanjeev Nath Yuliya Bababekova Alyssa Taussig Ivan Bodis-Wollner Alfredo A. Sadun Piero Barboni Valerio Carelli

Ajax George, MD Dr. Ajax E. George is the senior attending Neuroradiologist at NYU Langone Medical Center with a CAQ in Neuroradiology. He is a Professor of Radiology at the New York University School of Medicine in Manhattan, New York. After completing a combined college and medical school program at the National University Medical

Jerome Sherman, OD, FAAO Jerome Sherman, O.D., is perhaps optometry's most prolific writer, publishing over 650 clinical articles, research manuscripts, book chapters and two CDs. He is senior author of three books that were published in 2007, and has delivered over three thousand lectures both nationally and internationally. He has served as a contributing

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Follow-up and Implications to the Eye Clinician Although our patient has no neurological symptoms, a comprehensive neural evaluation has been initiated. Genetic testing will also be obtained2-9Neurological disorders may result in loss of retinal tissue.RNFL thinning in a glaucoma suspect may not be due to glaucoma but to an unrelated neurological disorder.As this case suggests,

Comments and Conclusions This patient has diffuse retinal thinning which appears to be related to diffuse loss of cortical tissue. Substantial loss of cerebellar tissue may occur prior to neurological symptoms. Specifically, loss of much of the cerebellum can occur prior to balance and coordination problems as this case demonstrates. Similarly, loss of RNFL

When a RNFL loss is not due to Glaucoma V - vascular I - infectious T - trauma A - autoimmune M - metabolic I - inherited N - neurodegenerative E - endocrine S - senile V - vitamin deficiency I - inflammatory T - toxic A - allergic M - mass

Comparative Sagittal MRI The above images compare the sagittal MRI scans of a normal control (left image) and the 49 year old patient (right image). The subject shows volume loss in the ventral pons (blue circle) and cerebellum (red circle) when compared to the normal control.