cranial nerves and neuro ophthalmology

Question 1

primary and secondary action of superior oblique

Answer 1

depression/intorsion

Question 2

primary and secondary action of superior rectus

Answer 2

elevation/intorsion

Question 3

primary and secondary action of inferior oblique

Answer 3

elevation/extorsion

Question 4

primary and secondary action of inferior rectus

Answer 4

depression/extorsion

Question 5

Result of sympathetic innervation to eyelid

Answer 5

innervates muller’s muscle and superior tarsal muscles in the upper eyelids, and inferior tarsal muscles in the lower lid.

Question 6

location of carotid dissection that leads to anhidrosis

Answer 6

beyond carotid bifurcation (because sympathetic fibers travel with the ECA).

Question 7

first order neuron in Horner’s

Answer 7

posterior hypothalamus to C8-T2 (spincocilliary center of budge)

Question 8

second order neuron in Horner’s

Answer 8

C8-T2 to sup. cervical ganglion (carotid bifurcation). Note, travel over apex of lung and under subclavian.

Question 9

3rd order neuron in Horner’s

Answer 9

sup. cervical ganglion along branches of carotid

Question 10

path of 3rd order synmpathetic neuron to face sweat glands

Answer 10

along ECA

Question 11

path of 3rd order sympathetic neurons to pupillary muscles and eyelid muscles.

Answer 11

along ICA, through cavernous sinus, with V1 to orbit.

Question 12

Use of cocaine in a meiotic eye

Answer 12

in a sympathetically denervated eye cocaine will NOT cause pupil dilation in a Horner’s syndrome, confirming the Horner’s. Does not further localize.

Question 13

Location of lesion in Horner’s if pupil dilates after hydroxyamphetamine.

Answer 13

First or second order neuron.

Question 14

Location of lesion in Horner’s if pupil DOES NOT dilate after hydroxyamphetamine.

Answer 14

3rd order.

Question 15

which oculomotor complex subnucleus innervates the contralateral side?

Answer 15

superior rectus subnucleus.

Question 16

pathway of afferent limb of pupillary light reflex

Answer 16

retinal ganglia-> optic nerve -> chiasm -> optic tract-> ipsilateral pretectal nucleus (note each pretectal nucleus gets info from contralateral visual field) -> Edinger Westfal nucleus.

Question 17

Pathway of efferent limb of pupillary light reflex.

Answer 17

Edinger Westfal nucleus-> oculomotor nucleus. ->oculomotor n.–> ciliary ganglia -> (postganglionic) pupilary sphincter.

Question 18

Lesion location in INO if the left eye cannot adduct.

Answer 18

LEFT MLF (lesion is IPSILATERAL to eye with adduction deficit.

Question 19

Findings in bilateral MLF lesions

Answer 19

bilateral exotropia causing “wall eyed bilateral INO (WEBINO).

Question 20

Lesion location in one and a half syndrome if right eye has no horizontal movement and left eye only has abduction.

Answer 20

RIGHT abducens nucleus or PPRF AND RIGHT MLF.

Question 21

suspected location of lesion in Adie’s tonic pupil

Answer 21

parasympathetic post-ganglionic

Question 22

findings in acute phase of Adie’s tonic pupil

Answer 22

unilateral mydriasis and lack of reaction to light or accommodation, constriction (hypersensitivity) to dilute pilocarpine.

Question 23

findings in chronic phase of Adie’s tonic pupil.

Answer 23

unilateral meiosis at rest, lack of reaction to light, intact reaction to accommodation.

Question 24

most likely diagnosis in adult patient with heart disease who has acute onset painless vision loss and nerve head edema.

Answer 24

Anterior ischemic optic neuropathy.

Question 25

signs of cavernous sinus syndrome

Answer 25

proptosis, blurred vision, deficits in CN III, IV, VI, V1 and V2

Question 26

5 features of central vertigo

Answer 26

1.absent latency 2. non-fatiguing 3. lasts longer than 1 min 4. not diminished by visual fixation 5.can occur in any direction.

Question 27

6 features of peripheral vertigo

Answer 27

1. latency present 2. fatiguable 3.lasts 1-20 seconds 4. improves with visual fixation 5.usually horizontal but can have torsional component 6. unidirectional.

Question 28

direction of slow phase of nystagmus in peripheral vertigo

Answer 28

slow phase is towards affected ear.

Question 29

in what direction does amplitude of nystagmus in peripheral vertigo increase.

Answer 29

when looking towards the unaffected side.

Question 30

in the ear, what are the otolithic organs

Answer 30

saccule and utricle

Question 31

what type of motion do the otolithic organs detect

Answer 31

linear and vertical acceleration

Question 32

what type of motion do the semicircular canals detect.

Answer 32

angular head motion

Question 33

path of parasympathetic input to glands of eye and nasal mucosa.

Answer 33

sup. salivatory nuc --> nervus intermedius --> geniculate gangion (no synapse) -->greater petrosal n. --> pterygopalatine gangion -->glands

Question 34

Path of parasympathetic input to the mouth.

Answer 34

sup salivatory nuc-->nervous intermdius--> geniculate ganglion (no synapse) --> chorda tympani -->submandibular gangion --> glands.

Question 35

first branch of facial nerve after the geniculate ganglion

Answer 35

nerve to stapedius.

Question 36

path of taste afferents from anterior 2/3 of tongue.

Answer 36

tongue-->chorda tympani-->through ext aud meatus-->geniculate nucleus (synapse) -->nervus intermdius -->tractus solitarius in brainstem.

Question 37

which brainstem nucleus gives rise to parasympathetic input to the parotid gland via CN IX?

Answer 37

inferior salivatory nucelus.

Question 38

which foramen does CN IX exit?

Answer 38

jugular foramen.

Question 39

what is the path of afferents from the posterior 2/3 of the tongue (taste)?

Answer 39

tongue--> glossopharyngeal n. --> superior and inferior ganglia (at level of jugular foramen) -->tractus solitarius.

Question 40

afferent and efferent path of baro-receptor reflex.

Answer 40

carotid baro-receptors--> CN IX --> nucleus solitarius -->interneuron --> Dorsal nucleus of X --> Vagus -->heart.

Question 41

afferent and efferent path of gag reflex

Answer 41

pharynx--> CN IX -->superior and inferior glossopharyngeal ganglia--> tractus solitarius--> nucleus ambigus -->CN X-->pharyngeal muscles.

Question 42

inputs to nucleus solitarius

Answer 42

1. taste afferents via CN VII and CN IX 2. sensory from CN IX (pharynx and baroreceptors).

Question 43

outputs from superior salivatory nucleus

Answer 43

parasympathetic efferents via CN VII.

Question 44

outputs from inferior salivatory nucleus

Answer 44

parasympathetic efferents via CN IX.

Question 45

outputs from nucleus ambigus

Answer 45

motor efferents via CN IX, X and XI

Question 46

direction of tongue deviation if lesion is supranuclear

Answer 46

contralateral

Question 47

direction of tongue deviation if lesion is hypoglossal

Answer 47

ipsilateral

Question 48

what motion does accessory nerve activation cause

Answer 48

ipsi head tilt, contra head rotation.

Question 49

what nerve supplies tactile sensation to anterior 2/3 of tongue?

Answer 49

Trigeminal

Question 50

what passes through the superior orbital fissure?

Answer 50

CN III, CN IV, CN V1

Question 51

what foramina does V2 pass through?

Answer 51

foramen rotundum

Question 52

what foramina does V3 pass through?

Answer 52

Foramen ovale

Question 53

What passes through the jugular foramina

Answer 53

sigmoid sinus, CN IX, X, XI

Question 54

what structure does CN XII pass through

Answer 54

hypoglossal canal

Question 55

what passes through the internal acoustic meatus

Answer 55

CN VII, CN VIII

Question 56

what causes sudden painless vision loss preceded by transient monocular blindness?

Answer 56

central retinal artery occlusion.

Question 57

what is the most likely diagnosis in a patient with sudden painless vision loss and jaw claudication.

Answer 57

Giant cell arteritis.

Question 58

what disorder consists of slowly progressive nonfatiguable ptosis and ophthalmoplegia with onset after age 30?

Answer 58

chronic progressive external ophthalmoplegia (CPEO)- a mitochondrial disorder.

Question 59

what sort of nystagmus occurs in Chiari malformation?

Answer 59

downbeat- occurs with lesions at the craniocervical junction.

Question 60

in what disorders does upbeat nystagmus occur?

Answer 60

cerebellar and brainstem lesions, wernike's encephalopathy

Question 61

what type of nystagmus is associated with suprasellar masses?

Answer 61

see-saw

Question 62

what is the most common cause of convergence retraction nystagmus in a newborn?

Answer 62

congenital aqueductal stenosis

Question 63

what is the most common cause of convergence retraction nystagmus in an older child

Answer 63

pineal tumor

Question 64

what is the most common cause of convergence retraction nystagmus in someone in their 20's?

Answer 64

head trauma

Question 65

what is the most common cause of convergence retraction nystagmus in someone in their 30s?

Answer 65

brainstem vascular malformation

Question 66

what is the most common cause of convergence retraction nystagmus in their 40's?

Answer 66

MS

Question 67

what is the most common cause of convergence retraction nystagmus in someone in their 50's?

Answer 67

basilar artery stroke

Question 68

what makes up mollaret's triangle?

Answer 68

red nucleus, ipsilateral inferior olivary nucleus, contralateral dentate

Question 69

what is the most frequent muscle involved in grave's eye disease?

Answer 69

inferior rectus

Question 70

what nerve is most often affected in ophthalmoplegic migraine?

Answer 70

Oculomotor

Question 71

what are the main features of ophthalmoplegic migraine?

Answer 71

onset before age 10 history of typical migraine ophthalmoplegia is ipsi to headache ophtalmoplegia starts at peak of headache and persists after headache is gone.

Question 72

what disorder is associated with bilateral subcapsular cataracts?

Answer 72

NFII