6.1.14 Flashcards
What are sudden vision changes that could indicate neurological conditions?
Blurry vision, double vision (diplopia), loss of vision.
Sudden changes in vision could point to neurological conditions such as optic neuritis, stroke, or papilledema.
What is diplopia?
Double vision, a common symptom indicating potential neurological problems, particularly involving cranial nerves responsible for eye movement.
What does pain with eye movement suggest?
Conditions like optic neuritis or raised intracranial pressure due to a space-occupying lesion.
What is an afferent pupillary defect (APD)?
A sign that could indicate optic nerve pathology.
What might ptosis indicate?
Cranial nerve palsy (e.g., 3rd nerve palsy) or other neurological issues.
What does loss of peripheral vision suggest?
Optic neuropathy or glaucoma.
What is ocular motility dysfunction?
Limitation of eye movement, especially when associated with diplopia, indicating problems with extraocular muscles or cranial nerves.
What does homonymous hemianopia indicate?
Damage to the optic tract or visual cortex.
What are the signs and symptoms of Third Nerve Palsy?
- Ptosis
- Exotropia
- Fixed dilated pupil
- Loss of accommodation
What are possible causes of Third Nerve Palsy?
- Aneurysm (especially posterior communicating artery)
- Diabetic neuropathy
- Trauma
- Ischemic events
What is the management for Third Nerve Palsy?
Immediate referral to neurology and neuroimaging (CT/MRI) to rule out aneurysm or intracranial pathology.
What are the signs and symptoms of Fourth Nerve Palsy?
- Vertical diplopia
- Head tilt to the contralateral side
- Difficulty reading or going down stairs
What are possible causes of Fourth Nerve Palsy?
- Congenital or acquired due to trauma
- Ischemia
- Systemic conditions like hypertension and diabetes
What is the management for Fourth Nerve Palsy?
Referral for neuroimaging and possibly prism glasses for diplopia.
What are the signs and symptoms of Sixth Nerve Palsy?
- Horizontal diplopia
- Affected eye turning inward (esotropia)
- Difficulty moving outward
What are possible causes of Sixth Nerve Palsy?
- Intracranial hypertension
- Diabetes, hypertension, or vascular causes
- Trauma or tumors
What is the management for Sixth Nerve Palsy?
Immediate referral for neurological assessment and neuroimaging, with possible use of prism lenses.
What is the first step in managing neurological conditions in optometry?
Comprehensive history taking, including inquiries about vision changes and neurological issues.
What should be included in an ocular examination for neurological conditions?
- Assess visual acuity
- Pupil reactions
- Ocular motility
- Fundus for optic disc swelling or hemorrhages
What is an important referral step if neurological signs are suspected?
Refer immediately to neurology for further investigation.
How can Third Nerve Palsy be explained to a patient?
“The nerve that controls the muscles around your eye isn’t working properly, which is why one of your eyelids is drooping, and your eye is not moving the way it should.”
How can Fourth Nerve Palsy be explained to a patient?
“This condition affects the nerve that helps move your eye when you look down, causing double vision, especially when reading or going down stairs.”
How can Sixth Nerve Palsy be explained to a patient?
“The nerve that moves your eye outwards isn’t working, which is why your eye is turning inwards.”
What is the primary distinction to make when assessing cranial nerve palsies?
Differentiating between neurological conditions versus systemic or vascular issues
What are common causes of ischemic nerve palsies?
- Diabetes
- Hypertension
Which cranial nerve palsy is most commonly associated with aneurysms?
3rd nerve palsy
What types of lesions can affect cranial nerves and present similar symptoms to palsies?
- Tumors
- Space-occupying lesions
What systemic disease is known to cause ischemic palsies, particularly affecting the 3rd nerve?
Diabetes mellitus
What is another common cause of ischemic damage to cranial nerves, especially the 3rd and 6th nerves?
Hypertension
Which systemic disease can lead to 4th nerve palsy?
Multiple sclerosis (MS)
What type of imaging is essential for diagnosing space-occupying lesions, tumors, or aneurysms?
Neuroimaging (MRI/CT)
What blood tests may be required if systemic causes like diabetes or hypertension are suspected?
- Glucose
- Blood pressure monitoring
When should a referral to neurology be considered?
For acute palsies that could indicate an aneurysm or intracranial pathology
What clinical examination technique involves testing for afferent pupillary defect (APD)?
Pupil testing
What test is used to identify strabismus or eye misalignment?
Cover/uncover tests
What is the urgency level for referral if an aneurysm is suspected?
Immediate referral
What should be monitored in patients diagnosed with cranial nerve palsies?
Progress of the condition and response to treatment
What type of lenses can be used for patients experiencing double vision due to cranial nerve palsy?
Prism lenses
What surgical intervention may be required for ptosis?
Levator muscle surgery
Fill in the blank: Immediate referral is necessary for suspected _______.
[aneurysm]
True or False: Diabetes-related cranial nerve palsies are considered non-urgent.
True
