In-Class Neurological and Eye Semiology

Question 1

Anisocoria with headache

LP

Acute angle-closure glaucoma

Sympathomimetic drugs

Answer 1

Should reaise suspicion for space ocupying brain lesion with uncal hernation and CN3 palsy…could be due to hemorrhage…get CT

Good for SA hemorrhage

May produce headache with dilated pupil but eye will be red and eye pain will predominate

Bilateral puillary dilation that constricts to light

Question 2

EOM

Answer 2

LR6SO4AR3

Question 3

CN 3 palsy

Answer 3

Command should be to look up

Eye deviated laterally and inferiorly

4 - depressed and intorted
6 - abducted

Ptsosi - loss f levator

Mydriasis - loss of PS innervaiton

Question 4

Org of CN 3 palsy

Answer 4

External pressure will first hit PS fibers…brain hernation, tumor, aneurysm

Nerve infarction will only affect motor function - diabetes

Question 5

Abducens palsy diff

MS

MG

Answer 5

Inc ICP, meningeal processes, dz of cavernous sinus, dz of neuropathy (diabetes) and vascular dz with brainstem ischmiea in the pons

MS - INO…no ICP or cranial nerve involvement but nuceli affected

MG - weakness beginning with muscles of face

Question 6

CN 6 palsy

Answer 6

Problem with abduction

Diabetes
Inc ICP
Meningeal processes like infection and cancer

Tell pt to look left and look right

Question 7

INO and MS

Answer 7

Failure of adduction TO the involved side

Unilateral from stroke…bilateral from demyelinating dz

MS - visual loss, diplopia, gait disorders, generalized fatigue

Lhermittes sign - transient electric shock like sensation from neck flexion - cervial SC path

Question 8

INO commands

Answer 8

Look at me, look right, look left

Question 9

MCA stroke

Answer 9

Sensory AND motor findings with lack of leg involvement

Speech center on opposite site of handedness

Graphesesia should be abnormal oin inovlved side

Question 10

Romberg
Dysmetria
Dolls eyes
Inability to furrow forehead
Plamomental

Answer 10

POst column
Cerebellum
Pontomedullary jxn 
Facial nerve 
Front lobe pathology

Question 11

Cortcial vs lacunar

Path
Clinical findings
Other findings
Sensorium

Answer 11

Cortical - cell bodies
Lacnuar - axons

Cortical - aphasia, apraxia, agraphesthesia, asterognosis

COmmon snesorium altering in cortical

Question 12

Argyll-Robertson pupil

MG/ALS

Endocarditis

Cavernous sinus thrombosis

Answer 12

Small irregular pupils that don’t react to light but DO accomodate

Neurosyphilis, diabetes, lyme dz, MS

MG and ALS - muscle weakness but no pup probs

Endocarditis - roth spots and hematogenous spread of infection

Facial edema and CN palsies

Question 13

Holme’s adie

Answer 13

Irregular dilated - initially unilateral but may progress to bilateral

Delayed ocnstrictio nto accommodation

Loss of DT reflexes

Question 14

Horners causes

Tertiary syphilis

Thalamic hemorrhage

Poorly controleldd DM

Answer 14

Cancer, SC dz, neck mass, vascular aneurysm and or dissection…affarnet pupil will react to light

Argyll robertson

Uncal hernaiton and CN3 nerve palsy

May isolate CN3 or 6 palsy

Question 15

Papilledema

Answer 15

High pressure htrough optic nerve

Systemic arterial pressure (malig HTN)
Venous pressure (central retinal vein occlusion)
High ICP

Question 16

HTN retinopathy

Answer 16

Cotton wool spots 
Flame hemorrhages
AV nicking 
Silver wiring/copper wiring 
Hard exudate

Question 17

Central retinal artery occlusion

Answer 17

Pale and avascular retina

Question 18

Cotton wool vs. roth

Answer 18

Wool - edge of micro-retinal infarct associated with HTN, diabetes, SLE, and venous infarcts

Roth - hemorrhage with a white center - IE

Question 19

Diabetic dot and blot retinoapthy

Answer 19

Reflects retinal capillary microanuerysms and intra retinal hemorrhage

Question 20

Causes of CN7 palsy

Answer 20

Viral infection +/- AI…other may be sarcoidosis, Lyme dz, HIV

Tell pt to close eyes

Question 21

Speech centers

Answer 21

Dominant cerebral hemisphere

Anomic aphasia from inf parietal lobe (angular gyrus)

Broca - inf frontal cortex

Wernicke - sup termporal lobe

Question 22

Bifacial weakness

Answer 22

MG - involves bulbar initally producing diplopia, speech probs, ptosis, etc.

G-B starts distal and ascends

Question 23

Bilateral ptosis

Answer 23

MG, Miller-Fisher of GB, botulism

Question 24

Genralized weakness

Answer 24

Spianl cord dz

Motor neruon dz
Demyelinating dz
Motor end-plaste dz
Myopathy

Question 25

Unilaterl weakness s

Answer 25

Carotid artery cortical stroke
Traumatic injury.nerve trap
unilateral spinal crod dz

Lacunar storke

Question 26

KNee extension
Knee felxors
Plantar flexors

Answer 26

L2-4 - femoral nerve
Sciatic nerve (L4-S3)
Tibial nerve

Question 27

Scelral icterus

Slecritis

Answer 27

Finding in hepatobiliary dz and brisk hemolysis

Painful due to systemic inflam condition (RA, vasculitis)…beings with red inflamed scelra…may cause sceral thinning and can see uvea

Question 28

Agrapehtestsia

Intention tremor

Post column

Answer 28

Contralateral to test hand

Cerebellar

Post column

Question 29

Etiologies of bilateral babinski

Answer 29

Vit B12 def of severe intox…soucl be bilateral cortical stroke

DM can produce symmetirc polyneuropathy but not UMN

Question 30

Syringomyelia

Answer 30

Bilaterla pain.temp loss and weaknessin upper extremities due to damage to anterir horn cells with reduced/absent refelx

Question 31

Alcohol withdrawl

Answer 31

Seizure in 1st few days but not associated with CN palsies of papilledema