Diseases of Visual Pathways/Dysfunction Flashcards

1
Q

What is anisocoria & it is present in what percent of the population?

A

(unequal pupil size) variant of normal

20%

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2
Q

What are the components of an eye exam?

A
  • V. A. testing
  • V. F. testing
    • confrontation
    • amsler grid
  • color perception & saturation
  • pseudochromatic plates
  • red cap test
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3
Q

Describe the pathway of the pupilary reflex

A
  • affarent (optic nerve taking info of light source to midbrain)
    • synapse in pretectal nucleus
    • following neuron synapses in CN III nucles
      • only one nucleus - shared btw eyes, which is why we get consensual pupilary response
    • CN III exits anterior brains stem with parasympathetic fibers
      • synapse in ciliary ganglion
      • final neruron innervates the pupil
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4
Q

How do we assess ocular motility?

A

cardinal fields of gaze

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5
Q

What is the term for misalignment of the eyes?

A

strabismus

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6
Q

What is the term for limitation of movement in one eye?

A

duction

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7
Q

What is the term for limitation of conjugate gaze?

A

version

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8
Q

Describe the sympathetic innervation of the eye & face

A
  • (origination sympathetic innervation eye & face) - hypothalamus
  • descend to midbrain & pons - terminate C8-T2 & synapses in iteromediolateral cells of spinal cord
  • exits central nervous system T1(still preganglionic) & move through sympathetic chain to synapse at superior cervical ganglion (C3/C4)
    • these postganglionic fibers are pseudomotor & vasomotor fibers
      • follow external carotids (innervate sweat glands & vessels of the face)
      • follow internal carotids (cavernous sinus; join CN VI into orbit & exit as long ciliary nerves)
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9
Q

What is the difference between true diplopia & monocular diplopia?

A
  • true diplopia
    • two separate images, one of which disappears when either eye is closed
  • monocular diplopia
    • not eliminated by closing the fellow eye
    • refractive problem, dry eye, or cataract
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10
Q

Vertical diplopia is associated with palsy of what CN?

A

CN IV

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11
Q

Horizontal diplopia is associated with palsy of what CN?

A

CN VI

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12
Q

What should you do if a patient comes in complaining of double vision?

A

thorough neurologic history & physical

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13
Q

What type of ptosis is seen with a CN III palsy?

A

complete ptosis

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14
Q

An eye cannot move in which direction in a CN III Palsy?

A

cannot adduct or look superior

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15
Q

An eye cannot move in which direction in a CN IV Palsy?

A

cannot depress

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16
Q

An eye cannot move in which direction in a CN VI Palsy?

A

cannot abduct

17
Q

What is the term for optic disc elevation is both eyes?

A

pipilledema

18
Q

What is the differential diagnosis of papilledema?

A

brain tumor / space occupying lesions

idiopathic intracranial hypertension (PTC)

cerebral trauma or hemorrhage

meningitis/encephalitis

dural sinus thombosis

19
Q

What does papilledema look like ona fundoscopic exam?

A

the nerve fiber starts to cover the vein on the side

& the disc appear larger than it should

(looks like an innertube)

20
Q

What arethe optic nerve disorders that are localized to the globe?

A
  • Papillitis
  • optic neuritis
  • ischemic optic neuropathy
    • nonarteritic
    • arteritic ion
  • amaurosis fugax (transient monocular blindness)
  • optic atrophy
21
Q

What bacterial agent can cause papilitis?

A
  • Cat Scratch Disease (bartonell henslae)
  • Toxoplasmosis
  • Treponema Pallidum
22
Q

What is the term for any visual field defect?

A

scotoma

23
Q

What is the term for los sof half the visual field?

A

hemianopia

24
Q

What is the term for similar right or left visual field loss?

A

homonymous hemianopia

25
Q

What is the term for loss of temporal visual field in both eyes?

A

bitemporal (heteronymous) hemianopia

26
Q

What is a common cause of bitemporal heteronymous hemianopia?

A

pituitary lesion

27
Q

Identify where the lesion is occurring for locations 1-8 & the resulting visual impairment

A
  1. Optic nerve lesion
    1. complete loss of visual field of one eye
  2. Optic nerve lesion close to chiasm
    1. Superior temporal cut in oposite eye
  3. Lesionis optic chiasm
    1. true bitemporal visual field defect
  4. Lesion in optic tract
    1. homonomous hemianopsia (loss of same field)
  5. Temporal defect
    1. “pie in the sky”
  6. lesion in lateral geniculate nucleus
    1. homonomous hemianopais (same as 4)
  7. Parietal defect
    1. inferior field defect
  8. Occipital defect
    1. usually some sparing of macular visual field d/t multiple bood supplies
28
Q

What is Charles Bonnet Syndrome?

A

Visual release hallucinations

people who have very good vision for most of their lives & then lost it (macular degeneration or trauma etc.)

the see things

29
Q

In what situations do patients with normal vision develop visula hallucinations?

A

dementia

30
Q

What is cognitive visual loss?

This can be a symptom of what condition?

A

not seeing well in spite of normal eye exam

difficulty with object recognition or inability to concentrate on more than one visual stimulus at the same time

Think dementia / Alzheimers

31
Q

How do you test for visual dementia?

A

clock drawing test