Anisocoria Flashcards

1
Q

Main things to worry about when someone has a dilated pupil

A

Dilated pupil + CN 3 palsy
-if pupil is involved, aneurysm, get to ER

If ONLY dilated pupil

  • put diluted pilo in the eye
  • constricts=Adies
  • doesnt constrict=pharmacological (scopolamine, plants)
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2
Q

Side effects of topamax

A

Bialteral angle closure

Myopic shift

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3
Q

If aniso is > in light

A

CN III
Adies
Pharm

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4
Q

If aniso is > in light

A

Syphillis
Horners
Uveitis

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5
Q

What is the correct definition of sensitivity

A

The probability of a test giving a positive result in patients with the disease

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6
Q

Adies tonic pupil

A

Acute dilated pupil due to an idiopathic lesion in the CG or the ciliary nerves, causing decreased innervation to the iris sphincter muscle

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7
Q

Who gets Adies

A

Most common in young (20-40) females. Typically unilateral but becomes bilateral at a rate of 4% per year

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8
Q

Short posterior ciliary nerves and Adies

A

Innervates the ciliary muscle and also arise from the ciliary ganglion, thus patients with Adies may also have decreased accommodation, resulting in a complaint of blur at near

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9
Q

Adies signs

A

Patients will present with minimal to no constriction of the affected pupil in response to light, but with a slow constrict in response to a near object. Anisocoria will be greatest under bright illumination due to poor innervation to the iris sphincter muscle (unable to constrict)

The iris will have a vermiform movement when looked at under slit lamp.
-decreased cell in CG but there are still SOME

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10
Q

Argyle Robertson pupil

A

Miotic pupil due to a lesion in the tectotegmental tract, which carries information from both pretectal nuclei to their respective ipsilateral and contralateral EW nuclei.

ARP

  • accommodative response present
  • FEF still working
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11
Q

What is Argyll Robertson pupil associated

A

Neurosyphilis
DM
Alcoholism

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12
Q

Signs of argyll Robertson pupils

A

Light-near dissociation (the pupil does not react or constricts poorly to light, but constricts normally in response to convergence and accommodation). Pupil constriction in response to near objects is controlled by the FEF, which is not affected here

Anisocoria will be greatest in the dark

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13
Q

Horners syndrome

A

Miotic pupil due to a lesion in the sympathetic nervous system pathway. Aniso will be greater in dark.

Classic triad of mild ptosis (poor innervation to mullers), miosis (due to poor innervation of the iris dilator), and anyhdrosis (due to lack of innervation to sweat glands)

Some less common findings: heterochromia, LL reverse ptosis, conj hyperemia, increased amplitude of accommodation

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14
Q

Pre-ganglionic central lesion for horners

A
From the hypothalamus to the ciliospinal center of Budge.
Causes
-CVA
-demyelinating disease
-tumor
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15
Q

Pre-ganglionic lesion in horners

A
From the ciliospinal center of Budge to the superior cervical ganglion 
Causes
-thyroid mass
-neck trauma
-Hx of thyroid or neck surgery
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16
Q

Post-ganglionic lesion for horners

A

From the superior cervical ganglion to the iris dilator
Causes
-head trauma
-cavernous sinus syndrome
-carotid dissection (pain and Hx of trauma)
-cavernous sinus fistula
-ICA aneurysm

17
Q

Pancoast tumor and horners

A

The most common pre ganglionic lesion

18
Q

Superior CN 3

A

Innervates levator and the SR

19
Q

Inferior CN3 innervation

A

IR, MR, IO

Parasympathetic fibers also travel along this division

20
Q

Complete CN3 palsy

A

Occurs when both divisions are impaired resulting in a lack of innervation to all 4 EOMs and the levator muscle; the eye will be directed down and out, with a significant ipsilateral ptosis. An incomplete CN 3 palsy is anything less than a complete 3 palsy

21
Q

Why might someone with a complete CN palsy not complain of diplopia

A

Because of the huge ptosis

22
Q

Most common causes of CN3 palsy

A

Microvascular infarcts, trauma, and aneurysms

23
Q

Pupillary fibers and CN3

A

Pupillary fibers travel on the outside of CN3; thus a pupil involving CN 3 palsy is much more likely to be caused by a compressive lesion rather than a microvascular infarct. Any pupil involving CN 2 palsy warrants immediate imaging with an MRI/MRA to r/o a compressive tumor or aneurysm (most commonly involving the PCA)

Because the pupil can rarely become involved after the initial presentation, patients with pupil sparing CN3 palsys should be monitored closely for 1 week to ensure the pupil does not become involved

24
Q

Topamax and its side effects

A

Indicated for the treatment of seizures, and is also RXed off label for the treatment of migraines and weight loss. It may result in superciliary fusion, causing an anterior shift in iris-lens diaphragm and subsequent angle closure (commonly within the first month or after an increase in the dosage). It will be bilateral

May also cause a myopic shift in refractive error

25
Treatment of angle closure from topamax
Dilate. The ONLY time you ever dilate an angle closure patient
26
Systemic association with Adies
Diminished deep tendon reflexes
27
Cocaine and/or apraclonidine for horners
Normal pupil-dilate Horners pupil-no dilation
28
Hydroxy in a horners pupil
Already confirmed with cocaine that it is horners, this tells us where it is Pre-ganglionic=dilation (1st and 2nd order) Post-ganglionic=no dilation (3rd order)
29
Treatment for Adies
There really isnt any | Just give them an add to help with blur at near
30
Specificity
The probability of a test giving a negative result when the patient does not have the disease
31
Positive predictive value
The probability that a patient has a disease when the test it positive
32
Negative predictive value
The probability that a patient does not have a disease when the test is negative