Disease Profiles: Neuro-Opthalmic Disease Flashcards

1
Q

List 4 causes of visual field defects

A

Vascular disease - CVA

Space occupying lesion (SOL) e.g. pituitary tumour

Demyelination (MS)

Trauma - including surgical

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2
Q

What is sudden onset diplopia?

A

Patient has changed from having binocular single vision, seeing one image only, to a sudden onset manifest squint and diplopia (double vision)

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3
Q

Describe the clinical presentation of optic neuritis

A

Progressive unilateral visual loss

Pain behind eye, especially on movement

Colour desaturation

Central scotoma

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4
Q

Horizontal double vision with esotropia/exotropia on cover test suggests a problem with which ocular muscles?

A

Medial or lateral rectus

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5
Q

Describe the clinical presentation of a CN IV nerve palsy

A

Typically results in vertical diplopia when looking inferiorly, due to loss of the superior oblique’s action of pulling the eye downwards

Affected eye turned upward in primary position

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6
Q

What pathology would result in a bitemporal field defect?

A

Optic chiasm defect - pituitary tumour, craniopharyngioma, meningioma

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7
Q

Describe the findings on fundoscopy associated with optic atrophy

A

Pale optic disc

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8
Q

What investigation us used to detect a manifest squint (topia)?

A

Cover test

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9
Q

Name 3 causes of papilloedema

A

Space-occupying lesion

Problems with cerebral blood flow (e.g. malignant hypertension)

Problems with CSF (obstruction to circulation, overproduction, inadequate absorption)

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10
Q

What causes sudden onset diplopia?

A

New weakness of extra-ocular muscles

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11
Q

What would be the most likely cause of a painful CN III palsy?

A

Aneurysm

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12
Q

What pathology would result in a contralateral homonymous hemianopia (macula not spared)?

A

Optic tract defect - tumours, demyelination, vascular anomalies

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13
Q

Which cranial nerve supplies all extaocular muscles except superior oblique and lateral rectus?

A

CN III

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14
Q

What is non-arteric ischaemic optic neuropathy?

A

ION due to non-inflammatory disease of small blood vessels - vascular risk factors

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15
Q

What is the most common cause of internuclear opthalmoplegia in a younger patient?

A

MS

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16
Q

Name the cranial nerve which supplies the superior oblique

A

CN IV

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17
Q

Describe the findings on fundoscopy associated with ischaemic optic neuropathy

A

Pale, swollen disc

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18
Q

Name a common cause of bilateral optic disc swelling in young females

A

Swelling of the optic nerve due to increased intracranial pressure

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19
Q

Name a complication of chronic papilloedema

A

Chronic papilloedema can cause axon damage leading to optic atrophy → loss of visual function occurs and blindness may result

20
Q

What pathology would result in a contralateral homonymous quadrantanopia (macula not spared)?

A

Optic radiation defect - tumours, demyelination, vascular anomalies

21
Q

Define ischaemic optic neuropathy

A

Occlusion of the posterior ciliary arteries, resulting in infarction of the optic nerve head

22
Q

What causes internuclear opthalmoplegia?

A

Injury/dysfunction in the medial longitudinal fasciculus (tract which acts as the central connection for the oculomotor nerve, trochlear nerve, and oculomotor nerve)

23
Q

Describe the clinical presentation of a CN VI nerve palsy

A

Results in unopposed adduction of the eye (by the medial rectus muscle), resulting in a convergent squint or esotropia (eye turns inwards)

Patients typically present with horizontal diplopia which is worsened when they attempt to look towards the affected side

24
Q

Name 4 causes of a CN VI nerve palsy

A

Microvascular

Raised intracranial pressure

Tumour

Congenital

25
Q

What autoimmune disease can cause ischaemic optic neuropathy

A

Temporal (giant cell) arteritis - posterior ciliary arteries become affected and the wall becomes so inflamed/thickened that lumen becomes occluded

26
Q

What pathology would cause unilateral visual loss?

A

Defect to the optic nerve - ishcaemic optic neuropathy, optic neuritis (commonly MS), tumours (meningioma, glioma, haemangioma)

27
Q

What causes optic atrophy?

A

End stage that arises from damage to the optic nerve of any cause

28
Q

Describe the findings on fundoscopy associated with papilloedema

A

Disc swelling (blurring)

29
Q

How can CN III nerve palsy cause miosis?

A

Loss of parasympathetic fibres responsible for innervating to the sphincter pupillae muscle

30
Q

Describe the prognosis of optic neuritis

A

Gradual recovery over weeks to months

31
Q

How can CN III nerve palsy cause ptosis?

A

Due to a lack of innervation to levator palpebrae superioris

32
Q

How might patients with IV palsies compensate for diplopia with variable head positioning?

A

Chin-down head posture is seen in bilateral CN IV palsy and contralateral head tilt is typically seen in unilateral CN IV palsy (common in children)

33
Q

Describe the clinical presentation of a CN III nerve palsy

A

‘Down and out’ appearance of the affected eye due to unopposed action of both the lateral rectus and superior oblique muscles, which pull the eye inferolaterally

Can also cause ptosis and miosis

34
Q

Define papilloedema

A

Swelling of the optic nerve due to increased intracranial pressure

35
Q

What pathology would result in a contralateral homonymous hemianopia with macular sparing?

A

Occipital cortex defect - vascular disease (CVA), demyelination

36
Q

Vertical double vision with hypertropia/hypotropia on cover test suggests a problem with which ocular muscles?

A

Superior oblique, superior rectus, inferior rectus, inferior oblique

37
Q

Describe the pathophysiology of papilloedema

A

When intracranial pressure rises, the increased pressure is transmitted to the subarachnoid space and then onto the optic nerve

This causes interruption of axoplasmic flow and venous congestion → swollen discs

38
Q

Describe the clinical presentation of papilloedema

A

Headache

Enlarged blind spot, blurring of vision, visual obscurations and loss of vision

N+V, especially if ICP rise is acute

39
Q

List 5 causes of a CN III nerve palsy

A

Microvascular

Tumour

Aneurysm

MS

Congenital

40
Q

What is the most common cause of internuclear opthalmoplegia in an older patient?

A

Generally have a vascular aetiology (stroke)

41
Q

Name the cranial nerve which supplies the lateral rectus muscle

A

CN VI

42
Q

Describe the clinical presentation of ischaemic optic neuropathy

A

Sudden visual loss

Usually painless

If associated with GCA - headache, scalp tenderness, enlarged temporal arteries

43
Q

List 4 causes of a CN IV nerve palsy

A

Congenital decompensated

Microvascular

Tumour

Blunt head trauma can result in bilateral CN IV palsy

44
Q

Describe the clinical presentation of internuclear opthalmoplegia

A

Impairment of adduction

45
Q

Define internuclear opthalmoplegia

A

Disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction

46
Q

Define optic atrophy

A

Death of the retinal ganglion cell axons that comprise the optic nerve