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Neurologic Conditions > Double Vision > Flashcards

Double Vision Flashcards

1
Q

What causes double vision?

A

Results from two eyes not moving synchronously together

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2
Q

What is Ophthalmoplegia or Ophthalmoparesis?

A

Weakness of eye movements

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3
Q

What is all weakness d/t?

A
  • Myopathy
  • NMJ disorder
  • UMN or LMN lesions
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4
Q

Any lesion of visual pathway ANTERIOR to optic chiasm produce ____ ____ ____.

A

Monocular visual distrubances

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5
Q

Any lesion POSTERIOR to optic chiasm produces ___ ___ ___ ___.

A

Hemianoptic visual field disturbances

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6
Q

What is Marcus Gunn pupil?

A

Afferent pupillary defect

Dilation in eye w/ light shining into it (swinging light test)

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7
Q

What does an optic chiasm lesion produce?

A

Bitemporal hemianopsia

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8
Q

What is the hx of a myopathy?

A
  • Subacute or chronic
  • Other weak muscles
  • Thyroid dz
  • Mitochondrial myopathies
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9
Q

What are the PE findings of myopathy?

A
  • Dysconjugate eye movements causing diplopia
  • Pupil is NEVER affected
  • Findings of thyroid dz
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10
Q

What are the PE findings of thyroid dz?

A
  • Myxedema
  • Exophthalamous
  • Slow relaxation phase of DTRs
  • Hair loss
  • Brittle nails
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11
Q

What are the presenting features in >90% if Myasthenia Gravis cases?

A

Diplopia &/or Ptosis

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12
Q

Who gets Myasthenia Gravis?

A

Young females & older males

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13
Q

What is the course of Myasthenia Gravis?

A

Subacute or chronic w/ waxing & wanning of sx

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14
Q

What are the PE findings of Myasthenia Gravis?

A
  • Ptosis
  • Diplopia
  • Pupil is NEVER affected
  • Dysarthria/dysphagia
  • Facial, axial or limb weakness
  • Normal DTRs & sensation
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15
Q

What dramatically improves Myasthenia Gravis sx?

A

IV injection of Endrophonium (Tensilon) a short acting acetylcholinesterase drug

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16
Q

What is Myasthenia gravis?

A

AI dz in which auto-Ab’s directed at post-synaptic Ach receptors at NMJ

17
Q

What is the tx for Myasthenia gravis?

A
  • Acetylcholinesterase drugs
  • Corticosteroids
  • Immuosuppressive drugs
  • Thymectomy if tumor or hyperplasia
18
Q

How can the Oculomotor nerve be damaged?

A

Mass lesion compressing b/w the edge of the tentorium & brainstem (herniation of the uncus of the temporal lobe) or by hematoma, neoplasm, etc

19
Q

What is the first thing that occurs in oculomotor nerve damage?

A

Dilation of pupil d/t peripheral PSN autonomic fibers followed by Opthalmoplegia of all the CN III innervated eye muscles

20
Q

What are the sx of Oculomotor nerve lesion?

A
  • Acute onset
  • Diplopia & ptosis of same eye
  • No waxing/waning
  • Multiple vascular RF
21
Q

What are the Vascular RF?

A
  • Advanced age
  • DM
  • HTN
  • Hyperlipidemia
  • Smokers
  • Vasculitis
22
Q

What is Ipsilateral Ophthalmoplegia?

A
  • Adduction is impaired
  • Abduction is intact
  • Pupil is unaffected
23
Q

What are the technological features of Oculmotor nerve lesion?

A

Brain MRI scans are normal or reveal incidental ABN

24
Q

What is the tx for Oculomotor nerve lesion?

A
  • Eye patch to reslove diplopia
  • Watchful waiting
  • RF reduction
25
Q

What are the PE findings of Abducens nerve lesion?

A
  • Ophthalmoparesis is paralysis/weakness of abduction w/ all extraocular fxn intact
  • Weakness, sensory loss, AMS, HA or papilledema if inc ICP or compressing CN VI
26
Q

What are the technological features of Abducens nerve lesion?

A

Brain imaging evidence of cause of inc ICP or indications of vascular RF

27
Q

What is the onset of Ophthalmoplegia?

A
  • Acute–Vascular in elderly
  • Subacute–Demyelinating in young
  • Gradual–Neoplastic
28
Q

What are the PE findings of Opthalmoplegia?

A
  • Unilateral or bilateral
  • Horizontal eye movements the adducting eye cannot cross the midleine & abducting eye develops nystagmus
29
Q

What are the technological features of Internuclear Ophthalmoplegia?

A

Brain MRI w/ & w/o contrast ID lesion in the pons b/w the nucleus of CN III & CN VI

30
Q

What is the hx of Wernicke’s Encephalopathy?

A

Alcoholism & nutritional def or other cond assoc w/ thiamine def such as gastric surgery & failure to take thiamine supplements

31
Q

What are the sx of Wernicke’s Encephalopathy?

A
  • Memory loss
  • Diplopia
  • Numbness & tingling
  • Confabulation
  • Ataxia
  • Peipheral neuropathy
32
Q

What are the tech features of Wernicke’s Encephalopathy?

A

MRI evidence of scattered deep white matter brain changes in upper brainstem & diencephalon or normal MRI

33
Q

What is the 1st finding to clear after giving IV thiamine to a Werneicke’s Encephalopathy pt?

A

Ophthalmoplegia

Neurologic Conditions (15 decks)

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