Cranial Nerve Palsy's

Question 0

What are the characteristics of Holmes-Adie’s Syndrome

Answer 0

The pupil is dilated and partly reacted to live with better response to accommodation.additional symptoms include diminish deep tendon reflex is an orthostatic hypertension the affected iris develops denervation supersensitivity which can be tested with application of 0.1% pilocarpine which does not affect the normal pupil but the affected pupil will show a slow but exaggerated response over 30 to 60 minutes. It will constrict more than the normal pupil

Question 1

Head tilt with superior oblique palsy in which direction exacerbates the lesion

Answer 1

Toward the lesion

Question 2

In Horner’s syndrome how do you differentiate pre-and post ganglionic lesions

Answer 2

Hydroxyamphetamine activates the post ganglionic sympathetic cell bodies and will lead to appropriate dilation of the eye if the lesion is pre-ganglionic dysfunction i.e. typical for apical Lung rumors. A post ganglionic lesion however will not show any dilation response most commonly due to carotid artery dissection

Question 3

What is Gradenigo syndrome

Answer 3

It is characterized by the triad of superlative otitis media, pain in the distribution of the trigeminal nerve and abducens nerve palsy

Question 4

How does cavernous sinus thrombosis present

Answer 4

With chemosis proptosis painful ophthalmoplegia and multiple cranial nerve deficits

Question 5

What is Millard-Gubler syndrome

Answer 5

This is caused by a Pontine lesion affecting cranial nerves six and seven and corticospinal tract with ipsilateral facial and abducens policy and contralateral hemiplegia