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Neurology > ILA 1 - unilateral loss of vision > Flashcards

ILA 1 - unilateral loss of vision Flashcards

1
Q

Which cells does MS attack?

A

Myelin cells produced by oligodendrocytes

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2
Q

Do get sensory, motor or cognitive problems MS?

A

ALL of them

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3
Q

Which immune cells in MS attack neurones? What do they need to cross and how do they do it?

A

T-cells. Cross BBB by using the correct ligand.

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4
Q

Which type of hypersensitivity reaction is MS? What does this mean it releases?

A

Type IV [cell-mediated]; releases cytokines Il-1, Il-6, TNF-alpha, INF gamma

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5
Q

What do cytokines in MS also attract?

A

b cells and macrophages

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6
Q

Early on the disease stage of MS, what may occur to neurones?

A

Remyelination. However, over time irreversible damage occurs with loss of axons.

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7
Q

Exact cause of MS?

A

Unknown but linked to genetics [females and genes HLA-DR2] and environmental RFs [infx and vitamin D deficiency]

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8
Q

What are the type of MS?

A 
4 types
- RRMS
- SPMS
- PPMS
- PRMS
Related to time scales.
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9
Q

Most common type of MS?

A

RRMS, with boughts happening months or years apart so loss of vision then improves [residual disability], step wise

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10
Q

Type is SPMS?

A

Constant degradation over time

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11
Q

PPMS

A

constantly going down

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12
Q

PRMS

A

progressively worse in between

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13
Q

What causes the variety of Sx in MS?

A

Location of plaques

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14
Q

Common age to develop Ms?

A

20-40 years old

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15
Q

What is Charcot neurological triad?

A

dysarthria, difficulty unclear speech, plaques brainstem with conscious movement like earring/talking, unconscious like swallowing

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16
Q

What is nystagmus?

A

Involuntary eye movements with plaques nerve eyes
optic nerve = loss of vision and optic neuritis
Movements: pain and double vision

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17
Q

Causes intention tremor in MS?

A

Plaques along motor pathways, muscle weakness and spasms, tremors and ataxia, paralysis

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18
Q

Plaques in the sensory pathways form skin in MS?

A

Numbness, pins and needles, parenthesis

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19
Q

What is Lhermittes sign?

A

electric shock radiates to the limbs

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20
Q

Plaques autonomic NS

A

bowel and bladder and sexual dysfunction

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21
Q

Higher order MS Sx

A

Poor concentration, critical thinking, depression, anxiety

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22
Q

Suspected MS is when?

A

When Sx spread over space and time

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23
Q

What is Dx of MS supported by?

A

MRI showing multiple white matter plaques
Also, in the cerebrospinal fluid high antibodies
Visual evoked potentials [?]

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24
Q

Tx for MS

A

for RRMS: corticosteroids, cyclophosphamide, IV Ig, plasmapheresis [remove Ab], immunosuppressants [recombinant B-IFN], other immunosuppressants
T xor progressive MS: fewer options, manage Sx like bladder control, CBT, vitamin D, physical therapy

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25
Q

Two common causes of ON?

A

optic nerve inflamed from infection or nerve disease.

Inflammation usually causes temporary vision loss that typically happens in only one eye.

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26
Q

Sx of ON

A

vision gets dim and blurry, can’t see colours, eye hurts when move them, common people with MS

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27
Q

Causes of ON

A

bacterial infection like Lyme’s, viral infections like measles and mumps, IAD like sarcoidosis, lupus, medications like quinine
Half of people with MS have ON. Immune system attacks myelin on optic nerve.

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28
Q

Dx for ON

A

Eye examination colour vision, smallest letters can’t read, side or peripheral vision

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29
Q

Treatment for ON

A

usually recovers by self, can have steroids

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30
Q

Go through steps eye examination

A
  1. Visual acuity [Snellen chart, pinhole for refractive error]
  2. Near vision [fine print]
  3. Colour vision [Ishihara chart]
  4. Visual fields
  5. Blind spot
  6. Inspect the external eye
  7. inspect the pupil [size, shape, symmetry]
  8. Eyelids
  9. Pupillary reflexes
  10. Astrabismus
  11. Eye movmeents
  12. Fundoscopy
  13. Red eye reflex
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31
Q 
Case
- 23 y/o W
- blurred and cloudy vision right eye
- present one week
- discomfort behind right eye
- vision worse when hot bath
- reduced light response R eye associated with reduced indirect response on the L
Likely Dx?
A

MS!

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32
Q

name of Sx worse hot bath

A

Uhthoff’s phenomenon. Differentiating form other conditions, body gets overheated.

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33
Q

What is the Marcus Gun pupil?

A

Look up

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34
Q

How to test for Marcus Gun pupil?

A

Swinging light I think

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35
Q

Cause of RAPD

A

look up

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36
Q

How to test for reduced visual acuity?

A

Snellen chart; first number is viewing distance, second the distance away an average eye can read

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37
Q

5 components for the anatomy of vision

A
  • aqueous humour
  • vitreous humour
  • retina
  • vascular
  • nerve
38
Q

Which component of vision does cataracts affect?

A

retina

39
Q

What does glaucoma effect?

A

Aqueous humour

40
Q

What is acute glaucoma?

A

Drainage of aqueous humour, suddenly becomes occluded.
Results in rapid rise in IOP.
Pain, red eye, nausea and vomiting.

41
Q

Sx and Sx of acute glaucoma

A

Very sick, nauseated, non-reactive pupils, painful red eye, look very unwell

42
Q

What can glaucoma often be confused by?

A

Migraine [DDx]

43
Q

What must you do with glaucoma like Sx?

A

Examine, as this cane easily missed.

44
Q

What is a vitreous haemorrhage?

A

Haemorrhage into vitreous humour.

Prevents light travelling from lens to retina.

45
Q

Signs of vitreous haemorrhage

A

Flashes/floaters, blurred vision.

Only becomes apparent flashes/floaters in fundoscopy.

46
Q

What is a retinal detachment?

A

Retina puled away from underlying surface.

Flashes, floaters, ‘curtain’ over part of vision.

47
Q

What conditions can flashes/floaters be seen in?

A

Vitreous haemorrhage and retinal detachment.

48
Q

What conditions can curtain over part of vision be seen in?

A

Retinal detachment but also vascular issues.

49
Q

What is the name for a swollen optic disc?

A

Anterior ischaemic optic neuropathy

50
Q

What causes the swollen optic disc in AION?

A

Occlusion of the posterior ciliary artery that supplies the head of the optic nerve.

51
Q

What should think of with AION?

A

GCA!

52
Q

how to treat AION and why important to Tx?

A

Give high dose steroids, or can lose vision.

53
Q

Sx and Sx of GCA

A
  • jaw claudication
  • scalp tenderness
  • anorexia
  • anorexia
  • fatigue
  • elevated ESR and CRP
  • over 70 y/o [though actually can be over 50]
  • no atherosclerotic RFs
54
Q

how does a central retinal artery occlusion appear?

A

Pale disc.

Cherry spots at macula.

55
Q

Cause of CRAO

A

occlusion of the central retinal artery [branch of the ophthalmic artery] which supplies the whole retina

56
Q

Mx of CRAO

A

urgent intervention, stroke opinion as consider TIA [throug eye clinic]

57
Q

Sx of central retinal vein occlusion

A

Dilatation of branch veins
Multiple retinal haemorrhages
Cotton wool patches around [hard exudate].
Distinct red picture on slides.

58
Q

Term used to describe inflammation involving the nerve head~?

A

Papillitis

59
Q

If papillitis is behind the nerve head, is that normal or abnormal?

A

Normal

60
Q

What does optic atrophy look like and what does it indicate has happened?

A

Indicates clonicity [optic nerve damage has been there a while].

61
Q

What does papilloedema look like?

A

Disc margins distorrted, haemorrhage in lower area.
Something pushing from the back centrally.
Swelling in this area of disc, means area is elevated.

62
Q

Main Sx of optic neuritis

A

Reduced visual acuity over few days. pain on moving the eye. Exacerbated by heat or exercise. Afferent pupillary defect. Dyschromatopsia.

63
Q

Aetiology of optic neuritis

A

Inflammation of optic nerve.
Often associated with MS. Can occur cliniically isolated syndrome.
Other causes include infection [Lyme, syphilis, HIV] B12 deficiency/arteritis]

64
Q

Course of ON

A

Recovery of vision occurs [6w]

65
Q

Tx of ON

A

Steroids help to reduce pain and hasten recovery

66
Q

Is it essential or not to have pupillary defect for a Dx of ON?

A

yes, essential to have afferent pupillary defect [I think]

67
Q

What can neuromyelitis optica lead to?

A

Long term damage [usually more severe version Sx, harder to Tx]

68
Q

What is the 15 year risk of developing MS if have episode of ON?

A

40%

69
Q

What indicator greatly increases the risk of developing MS after an ON episode?

A

If lesions on MRI:

  • if MRI normal at 10 years risk of MS is 11%
  • if MRI abnormal at 10 years risk of MS is 83%
70
Q

What is a clinically isolated syndrome that could be a possible sign of MS?

A

First attack of demyelination [e.g. ON]

71
Q

How is MS diagnosed? What criteria must be met?

A

Requires presence of multiple CNS lesions, which cause Sx that:

  • last longer than 24 hours
  • are disseminated in space [clinically, or on MRI]
  • are disseminated in time [over 1 month apart]
72
Q

List the typical features of MS

A
  • Visual loss [optic neuritis], RAPD, INO, optic atrophy
  • Pyramidal weakness, spastic paraparesis
  • Sensory disturbance
  • Cerebellar Sx [nystagmus, vertigo/tremor/ataxia/dysarthria/falls]
  • Bladder involvement/sexual dysfunction
  • Lhermitte’s and Uhthoff’s phenomenom
  • Fatigue
  • Cognitive impairment
73
Q

Which CN are commonly affected in MS?

A

3rd and 6th

74
Q

When does nystagmus typically present if it does in a pt with MS?

A

Later stages of the disease

75
Q

Why are cerebellar Sx common in MS?

A

Posterior fossa common sight for inflammation [so cerebellar Sx]

76
Q

What is Lhermitte’s phenomenon?

A

Shooting pain when bending neck

77
Q

Ix for MS

A

MRI scan
- T2 lesions found in 4 regions: juxtacortical, periventricular, infratentorial, spinal cord
LP
- unmatched oligoclonal bands

78
Q

When are oligoclonal bands typically useful?

A

patient two lesions [typical in MS], but can’t prove it’s a single episode over time, then LP unmatched oligoclonal bands can be helpful for Dx

79
Q

Describe the PP of MS

A

Inflammatory
Focal loss of myelin, with relative preservation of axons
Neurodegenerative axonal loss may contribute to fixed and progressive deficits

80
Q

What are the types of MS?

Describe course of each

A

Benign MS, RRMS, SCP, PP [10-20%].

Look at slides for course.

81
Q

Tx for an acute episode of MS

A

Steroids

82
Q

Benefits of taking steroids for MS

A

Doesn’t alter disease trajectory but hastens recovery [6-9 months disability the same]

83
Q

What should r/o after an acute episode?

A

Infection cause of disability [pseudorelapse]; if something systemic happens NX will decompensate well with for example arm weakness being caused actually by a UTI

84
Q

What should do before Rx steroids?

A

R/o infection of course. Do septic screen, examine them, check medication list.
If everything normal, then do MRI scan to see if any evidence of any new inflammation.

85
Q

Se of having steroids

A

Avascular necrosis, bad blood sugars, secondary Cushings, osteoporosis, peptic ulcers [etc.]

86
Q

Example pt which steroids may be useful for?

A

Young person who can’t skip 10d of work e.g.

87
Q

For chronic Sx, list disease modifying medication that are based on NICE guidelines

A
  • SC [traditional therapies]: inferferon beta, glatiramer acetate
  • oral e.g. fingolimod
  • IV e.g. natalizimab
  • stem cell transplant
88
Q

Which drug classes generally pretty effective for MS?

A

IV drugs like natalizimab. Though high SE profile.

89
Q

Which Rx is stem cell transplant good for?

A

Stem cell transplant good inflamatory phase, neurodegenerative phase less important

90
Q

How to examine RAPD/Marcus Gunn pupil?

A

Look up youtube

Neurology (13 decks)

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