CVA impairments pt. 2: vision & vestibular

Question 1

CN II and associated CNS areas damaged from CVA, what visual dysfunction will the pt have

Answer 1

CN II and associated CNS areas

• refractive errors
• myopia
• hyperopia
• astigmatism
• blurry vision, headaches, dizziness

Question 2

CN II and various regions of visual tract damaged from CVA, what visual dysfunction will the pt have

Answer 2

• impaired accomodation: blurry vision, HA, dizzy

- visual field loss

Question 3

cerebellum damaged from CVA, what visual dysfunction will the pt have

Answer 3

• impaired pursuits and saccades: dizzy, nausea, balance issues
• diplopia: nausea, balance issues

Question 4

CN II, III, IV, VI nuclei and associated CNS areas damaged from CVA, what visual dysfunction will the pt have

Answer 4

• ptosis
• ocular motility disturbances
• diplopia, visual distortions, dysconjugate gaze, impaired vergence: dizzy, nausea, balance issues

Question 5

optic n. lesion

Answer 5

ipsilateral blindness

Question 6

optic chiasm - bilateral lateral compression lesion

Answer 6

binasal hemianopia

Question 7

optic chiasm - midsagittal transection/pressure lesion

Answer 7

bitemporal hemianopia

Question 8

optic tract L lesion

Answer 8

right heminopia

Question 9

optic radiation L - lower division lesion

Answer 9

right upper quandrantanopia

Question 10

optic radiation L - upper division lesion

Answer 10

right lower quandrantanopia

Question 11

optic radiation L - both divisions lesion

Answer 11

right hemianopia with macular sparing

Question 12

tropia -

Answer 12

overt deviation of the eye

Question 13

phoria

Answer 13

ocular deviation occurs when dissociation occurs - when fatigued or doing a cognitive task

Question 14

esotropia is damage to what CN

Answer 14

loss of abduction

6 - abducens

Question 15

exotropia is damage to what CN

Answer 15

loss of adduction

CN 3

Question 16

hypertrophia is damage to what CN

Answer 16

loss of depression

CN3 and 4

Question 17

hypotrophia is damage to what CN

Answer 17

loss of elevation

CN 3

Question 18

if ocular misalignment issues is severe ..

Answer 18

diplopia
head tilt
noticeable eye turn

Question 19

if ocular misalignment is subtle ..

Answer 19

• diffuclty maintaining focus
• cosmetically normal
• oculare soreness
• HA
• mental dullness

Question 20

damage to cortical vestibular regions (PIVC, MST, VTR) impacts what

Answer 20

integration and regulation of vestibular systems

Question 21

damage to flocculonodular lobe results in what

Answer 21

VOR dysfunction

postural instabilities

Question 22

damage to brainstem vestibular regions (midbrain, pons) results in what

Answer 22

VOR, VSR, VCR dysfunction

Question 23

what is the most common complaint with vestibular dysfunction

Answer 23

dizziness

25% of ED visits due to dizziness are found to have a TIA/CVA

Question 24

transient ischemic attacks most common site:

what will you see with these

Answer 24

• vertebrobasilar artery
• vertigo
• visual deficits

Question 25

what are the two brainstem & cerebellar strokes that will have vestibular dysfunction

Answer 25

• PICA stroke (wallenbergs syndrome)

- AICA stroke

Question 26

what is the main presenting sign that helps you differentiate btw a PICA and AICA stroke

Answer 26

AICA will have hearing deficits

Question 27

what cortical stroke will have vestibular dysfunction

Answer 27

• MCA/PCA territory infarcts

- more mild symptoms

Question 28

where are the nuclei (and what are they) that are reliable for VOR dysfunction from a brainstem stroke

Answer 28

• midbrain: oculomotor nucleus

- pons: abducens nucleus