Eyes

Question 1

1 - Diabetic patient presents with diplopia, worse at a distance. Diagnosis, physiology of diplopia, and prognosis?

Answer 1

Ischemic abducens palsy (common in longstanding poorly controlled diabetics). Changing from near to long distance requires slight abduction of eye requiring CN VI. Not a brainstem lesion, often isolated finding, and good prognosis.

Question 2

3 - Patient with progressively blurred vision. On exam, cannot see through to the retina. Diagnosis? Iatrogenic cause?

Answer 2

Posterior subcapsular cataracts. Happens with chronic steroid use

Question 3

4 - Primary headache syndrome with stronger association with men (hint, it’s the only one)

Answer 3

Cluster headaches. Can be associated with miosis (constricted pupil), anhidrosis, and ptosis (Horners)

Question 4

6 - Paramedian pontine perforating vessel stroke can cause what neurologic abnormality?

Answer 4

Internuclear ophthalmoplegia

Question 5

7 - Painful loss of vision in one eye? (Pain with moving eye)

Answer 5

Optic neuritis (among other things). Fundoscopic exam will be normal an acute setting.

Question 6

8 - Elderly woman with joint and muscle pains diffusely presenting with recent onset blurred/lost vision? Diagnosis?

Answer 6

Polymyalgia rheumatica explains muscle aches and is associated with giant cell arteritis that can cause vision loss. Rx: high dose steroids, temporal artery biopsy

Question 7

9 - What is basilar migraine

Answer 7

More common in pediatric patients. Migraine with brainstem/cerebellar symptoms (dizziness, nausea, vomiting, confusion)

Question 8

10 - Sudden onset dilated pupil, drooping eyelid, slightly abducted eye. Diagnosis?

Answer 8

PCOM aneurysm compressing CN III

Question 9

11 - What eye abnormality is topomax (topiramate) associated with?

Answer 9

Angle closure glaucoma

Question 10

Trochlear nerve palsy will leave the eye in which position?

Answer 10

Sightly elevated and adducted

Question 11

13 - localization of a left homonymous superior quadrant visual defect? Including name of the anatomical structure affected.

Answer 11

Lesion of right Meyers loop in the temporal lobe. This is a part of the optic radiations from LGN to primary visual cortex that subserves the upper portion of visual system

Question 12

15 - significance of vision improving with pinhole testing?

Answer 12

Suggests vision problems are refractive or ocular and not neurological

Question 13

18 - reversible posterior leukoencephalopathy syndrome. What is it, what causes it?

Answer 13

Encephalopathy of the occipital lobe. Occurs from immunosupressive drugs (tacrolimus, cyclosporine) used in transplant patients. Also occurs with chemotherapy drugs. Patients will exhibit cortical blindness with intact pupillary responses

Question 14

2- Elderly patient presents with anemia, severe headaches, and jaw pain with chewing or biting down?

Answer 14

Temporal arteritis. The key here is the anemia. Remember GCA causes systemic issues like anemia and also causes jaw claudication. It is also more common in older people. Don’t be fooled by TMJ syndrome

Question 15

3 difference between meningioma and GBM on imaging?

Answer 15

Meningioma is extra axial and uniformly enhances. GBM has heterogenous enhancement

Question 16

4 - Key optho difference between a CN III palsy and a horners syndrome (ignoring extra ocular movements)?

Answer 16

Pupil dilation in CN III palsy from loss of parasymp (mydriasis), while constricted pupil in horners from loss of sympathetics (miosis)

Question 17

6 - medication for primary treatment of migraines (abortive medication)

Answer 17

Sumatriptan