differential diagnose longstanding and aquired Flashcards
what is longstanding and acquired
Recent assumes acquired
Longstanding may or may not be congenital
NOTE
Differentiate between longstanding/congenital and acquired
But, cannot differentiate between congenital and longstanding acquired
what is the history of recent vs longstanding
recent
May report exact cause
? Previous episode that has recovered
FH coincidental
Aware of AHP
longstanding
No obvious cause
May have attended as a child
Familial cases of 4th NP
Unaware of AHP
? Facial asymmetry
photographs - may show presence of ahp from childhood
what is the difference of recent and acquired when you occlude one eye
Recent:
AHP resolves on occlusion of one eye or in dark
Longstanding:
AHP maintained on occlusion of one eye or in dark
what is the difference between symptoms on a recent vs longstanding
recent
Sudden onset of symptoms
Diplopia
Very troubled by symptoms
Torsion (4th NP)
longstanding
Vague onset of symptoms
Diplopia absent/intermittent
Not so troubled by symptoms
Worse when tired
what is the difference between symptoms on a recent vs longstanding
recent
Sudden onset of symptoms
Diplopia
Very troubled by symptoms
Torsion (4th NP)
longstanding
Vague onset of symptoms
Diplopia absent/intermittent
Not so troubled by symptoms
Worse when tired
what would the difference on cover test be between recent and longstanding
recent
Incomitant deviation
Small deviation for degree of symptoms
longstanding
Fairly concomitant deviation
May be controlling large phoria
what is the difference between recent and longstanding for a recent and longstanding devation
recent
Any reduction in visual acuity is coincidental
(rarely could be associated with cause -pressure on optic nerve from tumour; previous retrobulbar neuritis etc)
longstanding
Amblyopia if manifest from early age
Reduced VA could be cause for decompensation
what are the differences between ocular movement and hess charts for recent vs longstanding deviations
longstanding
Incomplete muscle sequelae
Incomitant on Hess chart
recent
Muscle sequelae developed(may have difficulty identifying originally affected muscle)
Hess chart shows fields of similar size
what is the difference between angle of deviation for recent vs longtstanding deviations
recent
Incomitant
Angle greater fixing with affected eye
2° > 1°
longstanding
concomitant
Subjective adaptation to torsion
Objective > subjective
difference of >18º between subjective and objective measurement indicates subjective adaptation (McNamara et al, 1995)
what are the differences between longstanding and recent deviations
recent
Normal vertical fusion range
If no constant diplopia
No suppression (unless child)
NB Fusion may be affected in head injuries
longstanding
Increased vertical fusion range
If vertical deviation
Patients may have suppression in positions of gaze where manifest
how can vertical fusion ranges in superior oblique palsies be used to differentiate between congenital and acquired cases
SO palsy fusion range:
> 10 may be used in support of a congenital SO palsy (Sharma & Abdul-Rahim, 1992)
10 - 25 in congenital cases (Miller, 1985)
what does the field of bsv look like in recent vs longstanding
recent - small field for size of defect
longstanding - larger field for size of defect
what is past pointing and in what type of deviation is it present in
Misjudging the location of an object and pointing too far in the same direction in which the object was displaced when presented monocularly in the direction of action of a recently paralysed extraocular muscle.’
present in recent cases
absent in longstanding
