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
What autoimmune disease can cause ischaemic optic neuropathy
Temporal (giant cell) arteritis - posterior ciliary arteries become affected and the wall becomes so inflamed/thickened that lumen becomes occluded
26
What pathology would cause unilateral visual loss?
Defect to the optic nerve - ishcaemic optic neuropathy, optic neuritis (commonly MS), tumours (meningioma, glioma, haemangioma)
27
What causes optic atrophy?
End stage that arises from damage to the optic nerve of any cause
28
Describe the findings on fundoscopy associated with papilloedema
Disc swelling (blurring)
29
How can CN III nerve palsy cause miosis?
Loss of parasympathetic fibres responsible for innervating to the sphincter pupillae muscle
30
Describe the prognosis of optic neuritis
Gradual recovery over weeks to months
31
How can CN III nerve palsy cause ptosis?
Due to a lack of innervation to levator palpebrae superioris
32
How might patients with IV palsies compensate for diplopia with variable head positioning?
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
Describe the clinical presentation of a CN III nerve palsy
'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
Define papilloedema
Swelling of the optic nerve due to increased intracranial pressure
35
What pathology would result in a contralateral homonymous hemianopia with macular sparing?
Occipital cortex defect - vascular disease (CVA), demyelination
36
Vertical double vision with hypertropia/hypotropia on cover test suggests a problem with which ocular muscles?
Superior oblique, superior rectus, inferior rectus, inferior oblique
37
Describe the pathophysiology of papilloedema
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
Describe the clinical presentation of papilloedema
Headache Enlarged blind spot, blurring of vision, visual obscurations and loss of vision N+V, especially if ICP rise is acute
39
List 5 causes of a CN III nerve palsy
Microvascular Tumour **Aneurysm** MS Congenital
40
What is the most common cause of internuclear opthalmoplegia in an older patient?
Generally have a vascular aetiology (stroke)
41
Name the cranial nerve which supplies the lateral rectus muscle
CN VI
42
Describe the clinical presentation of ischaemic optic neuropathy
Sudden visual loss Usually painless If associated with GCA - headache, scalp tenderness, enlarged temporal arteries
43
List 4 causes of a CN IV nerve palsy
**Congenital decompensated** Microvascular Tumour Blunt head **trauma** can result in bilateral CN IV palsy
44
Describe the clinical presentation of internuclear opthalmoplegia
Impairment of adduction
45
Define internuclear opthalmoplegia
Disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction
46
Define optic atrophy
Death of the retinal ganglion cell axons that comprise the optic nerve