(41A) Eval of Vision Loss

Question 1

transient vision loss in both eyes simultaneously , think

Answer 1

basilar artery insufficiency

Question 2

what are amaurosis fugax?

Answer 2

unilateral transient loss in vision for 5 to 10 mins due to TIAs

Question 3

sudden loss of vision in one eye in an old person (>50), think?

in a young person?

Answer 3

old = arterial or venous occlusion

young = optic neuritis

Question 4

the presence of RADP usually is assc with diseases of …

Answer 4

opitc N
chiasm
or optic tract anterior to the exit of the pupillary fibers

** widespread retinal dz = AV occlusive disease

Question 5

+RAPD with normal appearing optic disc

Answer 5

optic neuritis

Question 6

what does a +RAPD indicate

Answer 6

there is a difference in the optic nerve conduction on each side
*equal damage to both optic nerves will so NO RAPD

Question 7

where must a lesion be found to cause scotoma in one eye

Answer 7

retinal or optic N

Question 8

where must a lesion be found to cause homonymous hemianopsia

Answer 8

behind the chiasm (cortex)

Question 9

where must a lesion be found to cause bitemporal hemianopsia

Answer 9

compression of the chiasm

Question 10

retinal vascular lesions respect the ____ midline and optic nerve lesions the ____ midline

Answer 10

vascular = horizontal

optic N = central scotoma

Question 11

young, middle age with sudden loss of vision in 1 eye + pain on motion of eye

Answer 11

optic neuritis

Question 12

where is the visual field defect in a pt with optic neuritis

Answer 12

central (pts cannot see object when they look directly at it but can if they use their peripheral vision)

Question 13

how is color vision affected in optic neuritis

Answer 13

red, color desaturation

Question 14

scotomas move with the pts eyes or is fixed in the visual field

Answer 14

moves with the eyes

Question 15

time course of optic neuritis

Answer 15

vision gets worse rapidly (10-14 days) and then slowly improves over 3 to 4 weeks

Question 16

treatment of optic neuritis

Answer 16

GCS

Question 17

optic disc appearance in retrobulbar ON and Papillitis

Answer 17

retrobulbar = optic disc nml 
papillitis = disc swollen

Question 18

how does the presentation of papilledema compare to papillitis

Answer 18

papilledema: nml VA, enlarged blind spot, -/+RAPD
papillitis: dec VA, central scotoma, + RAPD

Question 19

ON is frequently seen in …

Answer 19

MS

Question 20

most common cause of a lesion to the optic chiasm

Answer 20

pituitary adenoma

Question 21

homonymous hemianopsia, +RAPD, and optic atrophy

Answer 21

lesion between chiasm and LGN

Question 22

homonymous hemianopsia, nml RAPD, and NO optic atrophy

Answer 22

lesion between LGN and cortex

Question 23

location of lesions causing congruous vs incongruous homonymous hemianopsia

Answer 23

incongruous = more anterior 
congruous = posterior

Question 24

etiology of congruous homonymous hemianopsia in a young pt vs old pt

Answer 24

young = tumor
old = stroke
(on opposite side of field defect!!!)

Question 25

which CN might have a palsy with papilledema

Answer 25

6

Question 26

is VA affected by papilledema

Answer 26

no

Question 27

signs of papilledema

Answer 27

hyperemic and elevated disc
blurred disc margins
tortuous and dilated vessels
hemorrhages
spontaneous venous pulsations ABSENT

Question 28

acute loss of vision in 1 eye in an older pt
+RADP
swollen and pale disc
altitudinal hemianopsia

Answer 28

ischemic optic neuropathy

**looks similar to ON but in older pts

Question 29

“cherry red spot” appearance of macula

Answer 29

central retinal artery occlusion

Question 30

are optic cups large or small with optic atrophy

Answer 30

large

Question 31

asymptomatic damage to the head of the optic nerve secondary to inc ICP

Answer 31

chronic open angle glaucoma

Question 32

what visual field defect is seen in open angle glaucoma

Answer 32

peripheral then central vision loss