8: Eye in neurological disease

Question 1

What are the cardinal features of neurological eye disease?

Answer 1

Problems with eye movement - e.g diplopia

Visual field defects - test visual acuity and fields

Question 2

What causes neurological eye disease?

Answer 2

VASCULAR DISEASE!!!

Space occupying tumours

Trauma

Demyelinating diseases

Inflammation

Infection

Question 3

Which scan is used to check the brain for vascular disease and space occupying lesions?

Answer 3

MRI head

Question 4

Which mnemonic tells you the cranial nerve supplies to the extraocular muscles?

Answer 4

LR6 SO4 AO3

Question 5

Apart from elevation and depression, what do the oblique muscles do?

Answer 5

Superior oblique causes INTORSION

Inferior oblique causes EXTORSION

Question 6

Which cranial nerve palsy produces a medial manifest squint?

Answer 6

CN VI palsy

Question 7

What symptom does CN VI palsy produce?

Answer 7

Diplopia

Question 8

Patients with a CN VI palsy poorly (abduct / adduct) the affected eye.

Answer 8

abduct

Question 9

What most commonly causes a CN VI nerve palsy?

Answer 9

Raised ICP secondary to a vascular problem

Question 10

CN VI is compressed by raised ICP producing a palsy.

What sign is seen in the eye?

Answer 10

Medial manifest squint

Papilloedema

Question 11

What symptoms does a CN IV palsy cause?

Answer 11

Diplopia when looking DOWN (impaired depression)

Compensatory HEAD TILT due to intorsion

Question 12

In CN IV palsy, which direction does the affected eye look in the central position?

Answer 12

Upwards

Question 13

Why do patients with a CN IV palsy tilt their heads?

Answer 13

Superior oblique normally intorts the eye

So head tilt to compensate for that not working

Question 14

What is the most common cause of a CN IV palsy?

Answer 14

Congenital defcts

Question 15

What are common causes for any nerve palsy?

Answer 15

Microvascular

Tumour

Trauma

Question 16

What two muscles apart from the extraocular ones does a CN III palsy affect?

Answer 16

LPS

Sphincter papillae

Question 17

What position does the eye sit in due to CN III palsy?

Why?

Answer 17

DOWN AND OUT

Only lateral rectus and superior oblique are working

Question 18

What is the most common cause of CN III palsy?

Answer 18

Microvascular problems

Question 19

If a CN III palsy is painful what do you need to strongly suspect?

Answer 19

Aneurysm

Question 20

Life-threatening CN III palsies are caused by ___.

Answer 20

aneurysm

Question 21

6th raised icp

4th congenital, trauma

3rd aneurysm

Question 22

What is an example of a demyelinating disorder which causes visual loss?

Answer 22

MS

Question 23

Lesions before the optic chiasm cause which kind of visual field loss?

Lesions at the optic chiasm?

Lesions after?

Answer 23

Monocular vision loss

Bitemporal hemianopia

Loads of symmetrical visual losses e.g homonymous hemianopia. quadrantanopias etc.

Question 24

What is ischaemic optic neuropathy?

Answer 24

Optic nerve damage due to vascular causes

Question 25

What are the symptoms of optic neuritis?

Answer 25

Progressive unilateral visual loss

Pain on eye movement

Loss of colour vision

Scotoma (loss of central vision)

Question 26

Is optic neuritis reversible?

Answer 26

Yes, gradually

Question 27

What does a pale disc indicate?

Answer 27

Optic atrophy

Question 28

What causes bitemporal hemianopia?

Answer 28

Almost always pituitary tumours

Question 29

Is visual loss due to compression irreversible?

Answer 29

Not always

Question 30

Which compressions give you homonymous visual field losses?

Answer 30

Those AFTER optic chiasm

Question 31

What is the most common cause of visual field defects which should be eliminated along with space occupying tumours?

Answer 31

Vascular disease