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Fall 2014 Neuro Ophthalmic Disease > Fall 2014: Week 10: ION > Flashcards

Fall 2014: Week 10: ION Flashcards

1
Q

What’s the MOST common cause of Disc edema in Pts over 50?

A
  1. NA-AION
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2
Q

When does Optic Neuritis tend to occur? (age)

A
  1. Around 20-30s
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3
Q

Which of the following is the main blood supply to the Anterior part of the Optic Nerve?

a. CRA
b. ACA
b. LPCA
d. SPCA

A
  1. Short Posterior Ciliary Arteries
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4
Q

Which of the following Decrease BF to the Optic Nerve (MR)?

a. HBP
b. LBP
c. Very High IOP
d. Very low IOP
e. Dilation of terminal Aterioles
f. Constriction of Terminal Arterioles

A
  1. LBP;Very High IOP, and Constriction of Terminal Arterioles
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5
Q
  1. NA-AION is due to what?

2. A-AION is due to what?

A
  1. Non Perfusion of the Optic Nerve Head (Ischemia)

2. GCA (most common cause). (Inflammatory)

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6
Q

Pathophysiology of NA-AION

  1. Starts with ISCHEMIA of the ONH –> (4 more steps)
A

Axoplasmic Flow Stasis in the ON Fibers –> Axonal Swelling –> Optic Disc Edema –> Compression of the intervening Capillaries by Swollen Axons in the Crowded Disc

which then starts the whole process over…causing more Ischemia of the ONH.

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7
Q

NA-AION: Epidemiology

  1. US?
  2. More common in what age group?
  3. More common in what race?
  4. M >F?
A
  1. 2.3 to 10.2 per 100,000
  2. Middle-Aged and Elderly
  3. Caucasians
  4. No gender predisposition
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8
Q

Which of the following are risk factors for NA-AION?

  1. Nocturnal Hypotension
  2. Nocturnal Drop in IOP
  3. Small Optic nerve cup
  4. Lg. ON Cup
  5. Myopia
  6. Diabetes
  7. HTN
  8. Sleep Apnea
A

1, 3, 6, 7, 8.

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9
Q

NA-AION: “Disc at Risk”

  1. It’s well established that what cup size is a contributing factor in the pathogenesis of NA-AION?
  2. Eyes w/NA-AION have a HIGHER PREVALENCE of what than the general population?
A
  1. Absent or Small cup

2. Small cups

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10
Q

NA-AION: Symptoms

  1. Vision Loss: Acute, or slowly progressive? Painful?
  2. What else?
A
  1. Sudden, PAINLESS VISION LOSS (usually discovered upon awakening)
  2. VF Loss, and Decreased Color Vision
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11
Q

T/F: If a Pt w/a U/L NA-AION has a VA of 20/20 in the affected eye, they most likely will not have an RAPD

A

FALSE

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12
Q

What’s the most common type of VF Defect with NA-AION?

  1. What’s the Second most common VF Defect?
A
  1. INFERIOR ALTITUDINAL

2. Central Scotoma

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13
Q

NA-AION: ON Appearance

  1. Optic Disc Edema: Becomes pallid over what amt of time?
  2. What kind of Hemes are commonly seen?
A
  1. Over 4-6 wks. (Diffuse or Segmental).

2. Peripapillary Splinter Hemes

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14
Q

NA-AION: Diagnostic Criteria

  1. Age?
  2. Risk Factors?
  3. 1 or both eyes affected at a time?
  4. VA, and VF loss?
  5. Other CN involvement or Systemic Symptoms?
  6. c/d ratio in Contralateral eye?
  7. Stable vision loss at what time?
  8. GCA Labs?
A
  1. 50 or over
  2. Vasculopathic Risk Factors
  3. just one EYE
  4. Sudden VA and VF Loss w/no Progression beyond one week.
  5. None
  6. Small
  7. at one month
  8. NORMAL
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15
Q

NA-AION: Prognosis

About what % of eyes w/NA-AION show spontaneous improvement in VA?

  1. What is the chance that a pt with an NA-AION in one eye will develop an NA-AION in the fellow eye?
A
  1. 40%

2. 15-25%

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16
Q

NA-AION: Management

  1. Reduction of what?
  2. Manage what?
A
  1. Risk factors

2. Nocturnal Hypotension

17
Q

A-AION: GCA:

  1. GCA is what kind of disease that INVOLVES the medium and Large Arteries?
  2. A-AION in Pts w/GCA is the result of what?
A
  1. Vasculitis

2. Thrombotic Occlusion
Inflammation –> increased risk of thrombosis –> risk of blood clotting –> occlusion

18
Q

A-AION: GCA: Epidemiology

  1. Annual Incidence in US?
  2. Peeps?
    a. Mean Age?
  3. M>F?
  4. More common in what race?
  5. GCA is the cause of AIONs in what % of cases?
A
  1. 0.36 per 100,000
  2. Late middle-aged and elderly
    a. 70
  3. Females more common than males
  4. in Caucasians
  5. 5.7% of cases (So that includes all AIONs, Arteritic and Nonarteritic…)…but it’s the most common cause of A-AION
19
Q

What are the most common visual symptoms in GCA (3)

A

Amaurosis Fugax, Diplopia, and Sudden Vision Loss

20
Q

A-AION: GCA:

Persistent vision loss due to A-AION is preceded by Transient Vision Loss in what % of cases?

A

7-18% of cases.

21
Q

A-AION: GCA: Systemic Symptoms of GCA

  1. Most Common?
  2. Most Specific?
A
  1. HA

2. Jaw Claudication

22
Q

A-AION: GCA: Occult GCA

  1. What % of Pts w/Vision loss due to GCA have NO SYSTEMIC SYMPTOMS?
A
  1. ~21%
23
Q

A-AION: GCA: VF

  1. VF Loss in A-AION is more/less extensive and severe than inNA-AION?
A
  1. MORE
24
Q

A-AION: GCA: ON Appearance

  1. Pallor = ?
  2. What else is seen?
  3. Does A-AION Favor any particular cup size?
A
  1. “Chalky White” Optic Disc Edema
  2. Can have peripapillary splinter hemes, CWS
  3. Nope.
25
Q

A-AION: GCA: Diagnostic Tests

  1. what can be done?
  2. Why do we order CRP and ESR together?
A
  1. CRP
    ESR

and CBC (Thrombocytosis)

  1. Most sensitive (100%) and more specific (97%) when ordered together than by themselves
26
Q

A-AION: GCA: TAB

  1. What is found?
A
  1. Granulomatous inflammation of the Arterial Walls

Possible Multinucleated Giant Cells

*Skip Lesions

27
Q

A-AION: GCA: What’s the most common Tx for Pts w/GCA that present w/VISION LOSS?

A

High Dose IV steroids followed by Oral Steroids tapered over years

28
Q

A-AION: GCA: Tx

  1. Uncomplicated GCA (No jaw claudication or visual symptoms)
  2. Evolving visual loss or transient vision loss
  3. Established vision loss
A
  1. 40-60 mg oral prednisolone daily
  2. IV Methylprednisolone 500-1000 mg daily for 3 days then oral prednisolone
  3. At least 60 mg prednisolone daily
29
Q

A-AION: GCA: Which of the following are side-effects of long-term steroid treatment?

  1. Wgt Gain
  2. Hyperglycemia
  3. Cataracts
  4. Depression
  5. HBP
  6. Fatigue
  7. Osteoporosis
A
  1. ALL OF THEM
30
Q

A-AION: GCA: Management

  1. History
  2. Serology
  3. Bx?
A
  1. Symptoms of GCA
  2. CPR, ESR, CBC (if elevated, start Tx for GCA)
  3. TAB w/in 1-2 wks of Steroid Tx
31
Q

KNOW: GCA MUST be on your DDx for the following Conditions (4)

A
  1. AION
  2. CRAO
  3. TMVL (Transient Monocular Vision Loss)
  4. Diplopia
32
Q

PION

  1. Common?
  2. Dx of what?
  3. 3 types….
  4. Optic Nerve appearance?
A
  1. RARE condition that’s due to ischemia of the posterior part of the ON
  2. of EXCLUSION!
  3. Arteritic, Non-Arteritic, and Perioperative PION (This one is due to prolonged general anesthesia, Surgical trauma, massive blood loss, hemodilution)
  4. Normal –> Pallor (6-8 wks)

Fall 2014 Neuro Ophthalmic Disease (14 decks)

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