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Neuroanatomy 2 > Diplopia > Flashcards

Diplopia Flashcards

1
Q

How does monocular diplopia resolve?

A

With pinhole

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2
Q

If you cover one eye and the diplopia resolves…

A

Binocular diplopia -

1) Innervational misalignment
2) Mechanical misalignment

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3
Q

When do you see the maximum separation of images?

A

Position of gaze where the muscle is the weakest or most restricted. (left 6th N palsy, worse in left gaze)

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4
Q

CN4 palsy - head tilt

A

RIGHT 4 - head tilts to LEFT

LEFT 4 - head tilts to RIGHT

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5
Q

What conditions mimic blepharoptosis (eye lid ptosis)

A
  1. Hypotropia (lookin down close other eye, will look up)
  2. contralateral lid retraction seen in graves disease
  3. Dermatochalasis - loose skin
  4. Brow ptosis seen in bell’s palsy
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6
Q

What causes true ptosis

A
  1. congenital
  2. CN3
  3. Horners
  4. Myesthenia gravis
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7
Q

symmetric misalignment in all positions of gaze is called

A

Comitant
Childhood strabismus
Chronic innervational disease

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8
Q

Asymmetric mislignment greatest in position of most affected muscle

A

Incomitant
Innervational or
Mechanical

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9
Q

Examples of mechanical causes of incomitant binocular diplopia

A

Orbital fracture

Graves disease

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10
Q

Examples of innervation causes of incomitant binocular diplopia

A
  1. Stroke, brainstem
  2. cn 3,4, 6 PALSY
  3. internuclear opthalmoplegia
  4. myesthenia gravis
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11
Q

Graves disease - what happens

A

Accumulation of glucosaminoglycans in INFERIOR RECTUS and MEDIAL rectus - become thickened and pull eye down or in

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12
Q

Acquired conditions of cranial nerve palsies

A
  1. Ischemia
  2. tumor
  3. Demylination
  4. Trauma
  5. metabolic - thymine deficiency
  6. Myesthenia gravis
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13
Q

What is myesthenia gravis

A

Antibodies to Nicotinic acetylcholin receptors
- fatiguability -
IMITATOR - PUPIL NOT INVOLVED!!

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14
Q

What do you see in a patient with a 6th nerve palsy

A
  1. Esodeviation (eye is in)
  2. Horizontal diplopia
  3. Ischemia (hypertension/diabetes)
    EXCLUDE INCREASE ICP. PAPILLEDEMA
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15
Q

6th nerve palsy can be a….

A

FALSE localizing sign -
it is subject to compression
e.g. subcranial hemorrhage

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16
Q

Features of CN4 palsy

A
  1. hYPERtropia - affected eye - look up
  2. Head tilts to opposite side
  3. Positive 3 step test?
  4. Vertical/diagonal diplopia
17
Q

Causes of CN4 palsy

A
  1. TRAUMA most common
  2. Congenital
  3. Ischemia (diabetes hypertension)
  4. RARELY TUMORS OR ANEURYSM
18
Q

when you tilt your head to the right

A

Right eye INCYCLOTORTS

Left eye excyclotorts

19
Q

3 step test for SO - straight ahead gaze, lateral gaze

A
  1. Straight ahead, bad eye hypertropes
  2. Lateral gaze (OPPOSITE to affected eye) WORSE - unaffected inferior oblique - hypertrope
  3. Head tilt to affected side - overactive superior rectus - worse
20
Q

When is the pupil spared in 3rd nerve palsy

A

Likely MICROVASCULAR ischemia - central

If pupil is involved - THINK PCOM -

21
Q

Aneurysm of the pcom is like a

A

3rd nerve pupil bomb

22
Q

A medial rectus palsy is not necessarily a Partial 3rd nerve palsy! no think of something else

A
  1. Internuclear opthalmoplegia

2. Myesthenia gravis

23
Q

Orbital apex syndrome -

A
  1. RAPD if optic nerve is compressed

2. 3,4,6 palsy

24
Q

A carotid cavernous sinus fistula

A

can cause 6th cranial nerve palsy

25
Q

Pituitary apoplexy -

A
  1. CN3 palsy - no pupil affected

2. Bitemporal hemianopsia

26
Q

Which two conditions are least likely to present with loss of vision and binocular diplopia?

A
  1. 3rd nerve palsy and pcom aneurysm

2. Myesthenia gravis

27
Q

Which 3 conditions CAN cause double vision and loss of vision

A
  1. OPTIC NEURITIS
  2. pituitary apoplexy
  3. Giant cell arteritis
28
Q

In giant cell arteritis what is high?

A

platelets
ESR
CRP

29
Q

In strabismus surgery a recession will

A

weaken the muscle decrease tension

recess antagonis muscle… less double vision

30
Q

When do you perform a strabismus surgery

A

After 12 months

31
Q

Botox to right lateral rectus if they have 6th nerve palsy

A

IS not GOOD - botox relaxes the muscle -

make it WORSE - need to weaken the antagonist muscle - like medial rectus

Neuroanatomy 2 (25 decks)

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