2: Neurology + Development - Squint, Autism Flashcards
What is strabismus
misalignment of the visual axis
what are the two main types of squint
- Non- paralytic (Concomitant)
- Paralytic (Non-concomitant)
what is non-paralytic squint also known as
Concomitant
what causes a non-paralytic squint commonly
Most commonly due to refractive errors
what are other causes of a concomitant squint
Cataracts
Retinoblastoma
Intraoccular occlusion
what typically causes a paralytic squint
Often due to weakness of intra-occur muscles caused by denervation of cranial nerves. Therefore, check for intra-cranial lesion.
is a concomitant squint usually divergent or convergent
Convergent
When does a concomitant squint occur
Occurs in childhood
what is a convergent squint also called
Esotropia
what eye abnormality can lead to convergent squint
Hypermetropia
what is the risk of squints
The brain will not process the abnormal image. This affects development of the visual pathway causing visual amblyopia.
what is divergent squint also referred to as
Exotropia
what is exotropia
Bad-eye is turned outwards
what is a latent squint
When normally squint does not manifest as it is controlled by subconscious methods. However, when the individual is tired and subconscious control is lost, it may manifest.
what is a pseudo squint
Where an individual has wide epicanthic folds making it appear that they have a squint.
What are three indications for an ophthalmology review
- Divergent squint
- Suspect paralytic squint
- Squint does not resolve in 2 months
What are two tests for a squint
- Corneal Reflection Test
- Cover Test
Explain the corneal light reflection test
Light is shone on the cornea. If no squint is present, it should be reflected back equally on both sides.
What is the cover test
Each eye is covered up in turn. Movement is looked for in the uncovered eye
Explain the cover test in a convergent squint
When the good eye is covered the ‘bad’ eye will move temporally to assume its position
Explain the cover test in a divergent squint
When to good eye is covered the ‘bad’ eye will more nasally to take up its position
What are the three ‘O’s of managing a squint
Optics
Orthoptics
Operation
What is the ‘Optic’ of managing squint
Use cyclopentolate to relax the ciliary bodies and check the eye for refractive errors
What is used to correct refractive errors
Glasses
What is the orthoptics ‘O’ of managing squints
Use an eye patch to cover the good eye - this will encourage use of the eye with the squint
What operations may correct squint
Botox - may be used
Surgical resection to re-align rectus muscle
When should squint be treated by and why
If not treated within 7-years it can cause strabismus ambylopia
Explain strabismus amblyopia
In strabismus, there is discrepancy in two images projecting to the brain from the different eyes. This causes the brain to ignore input from one or both eyes. Lack of visual stimuli during plastic period (7-years) leads to cortical blindness
What are 4 common causes fo squint
Refractive Error
Congenital Cataracts
Browns syndrome
Duane’s retraction syndrome
What refractive error mostvcommonly causes squint
Hypermetropia
What is Brown’s syndrome
Eyes cannot move upwards
What is Duane’s retraction syndrome
Eyes cannot turn to the side
How did the DSM4 describe autism
autism was one of the pervasive developmental disorders (PDD). That also included Aspergers, childhood disintegrative disorder and not other specified
In the DSM4 what was asperger’s syndrome
Some features of autism but with no delay in cognition or language
what is child disintergration disorder
Child develops normally - then regresses in terms of social or language development from 2-10 years
what was not other specified in DSM4
Meet some features of autism
Describe autism in the DSM5
Autism spectrum disorder encompasses all of the above disorders of varying severity - it is scale on social communication and interaction deficits
What is the prevalence of autism
1:200
What gender are impacted more by autism
Males
What chromosome is associated with autism
11p12
What environmental factors contribute to autism
- Teratogens
- Peri-natal infection
When are children with autism often identified
2-4 years. As this is when language develops the most
What are the three features of autism
- Impaired reciprocal social interaction
- Poor range of activities + interests
- Impaired imagination
Explain impaired reciprocal social interaction
- Does not wave bye-bye
- Unaware to feelings of others
- Abnormal response to being hurt
- Repetitive play
Explain poor range of activities and interests
- Sterotyped movements
- Upset over trial things
- Follows routine
- Narrow fixation eg. lines toys up
Explain impaired imagination (language + communication)
- Poor babbling and facial expression
- Avoids eye contact
- Odd speech
- Difficultly reciprocating conversation
What are 5 associations with ASD
- Learning difficulties
- Intellectual impairment
- Epilepsy
- ADHD
- Rett Syndrome
What is Rett syndrome
Condition in girls 6-18. Present with hand wringing, odd facial expressions, sudden bouts of laughter, hand licking or hair grasping and chorea.
Explain how ASD is diagnosed
- Parents keep behaviour diary
- Modified checklist for autism in toddlers (M-CHAT) can be used as a screening tool
- Diagnosis is made by MDT assessment based on symptoms on ICD10
What is implemented to treat ASD
- Early intensive behavioural therapy including parent training, SALT, social skills training
What is early intensive behavioural therapy
special schooling before 3-years to improve communication and motor skills.
What is the benefit of parent training
improves parent-child interaction Reduces maternal depression
What medical treatment may be given in ASD for aggression
Risperidone
What medical treatment may be given in ASD for poor sleep
Melatonin
What medication may be given in ASD for repetitive behaviour
SSRIs
