Jakirlic Flashcards
Increased diameter of ONH
Stage 3 moderate
Normal temporal disk,
No elevation
Stage 1 very early
Complex metamorphopsia
Parietal tumor/stroke, parietal seizures and migraine. Persist covering both eyes
Brain tumor can cause
Complex hallucinations
Simple and complex illusions
Migraines
Simple hallucinations
Complex metamorphopsia
Pareto-occipital tumor/stroke causes
Complex Illusion:
Diplopia not changing covering both eyes
Polyopia
Palinopsia
Drug abuse
Can cause complex illusion called Palinopsia
Bilateral Occipito-Temporal lobe tumor/stroke
Complex Illusion-akinetopsia “motion blindness “
Hallucinations cause : simple
Retinal disease (PVD, tear, RD)
Optic nerve disease
Migraine: visual aura
Hallucinations cause : complex
Dementia Metabolic disease Illegal drug use Occipital tumor/stroke Occipital epilepsy Charles Bonnet Syndrome
Transient Visual Loss-Monocular
Incipient retinal vascular occlusion (CRAO, CRVO)
Retinal vasospasm (ocular migraine)
GCA
Papilledema (IIH) (usually bilateral but can be unilateral due posture change)
Amaurosis fugax (hypoperfusion)
Cardiac valvular disease
Most common cause of monocular vision loss
Amaurosis fugax (hypoperfusion) d/t carotid artery stenosis
Most common cause of binocular visual disturbance:
migraine
Non-migraine TVL
sign of serious vascular disease
Transient Visual Loss-Binocular
Migraine
Papilledema (IIH)
Vertebrobasilar insufficiency
Postural hypotension
Amaurosis Fugax
Sudden onset of severe visual loss in one eye
All or part of monocular visual field
Lasts seconds to minutes
Completely resolves within 10 minutes (can last up to 1 hour)
Fellow eye unaffected
No other neurologic symptoms
No symptoms of GCA
50+ year olds with cardiovascular risk factors
Amaurosis Fugax: examination
Normal ocular examination in both eyes
May visualize Hollenhorst plaque in retinal arteriole
Amaurosis Fugax Workup
Laboratory; CBC with differential ESR & CRP Hypercoagulable state in young patients Carotid artery investigation
Ocular Ischemic Syndrome
Entire eyeball suffers from hypoperfusion
Severe ICA stenosis or occlusion
GCA
Ocular Ischemic Syndrome Symptoms
Transient monocular visual loss or blur improved with laying down
Orbital ache improved on laying down
Dull ocular pain all around the eye that improves laying down.
Transient neurologic symptoms: contralateral weakness or numbness
Ocular Ischemic Syndrome signs
Decreased BCVA
Decreased IOP
Mild anterior uveitis
Retinal venous engorgement and tortuosity
Mid-peripheral retinal hemorrhages (classic sign)
Iris neovascularization
Cataract (forms quicker)
Ocular Ischemic Syndrome workup and treatment
Investigations: carotid doppler, ESR, CRP
Treatment
Carotid endarterectomy: symptomatic patients with severe 70-99% stenosis
Vasospastic monocular TVL
retinal migraine
Typically young adult
Same eye affected every time
Vertebrobasilar Insufficiency
Age 50+
Sudden onset visual loss in both eyes
Vision recovers completely within minutes (can take up to 1 hour)
Chiasmal Disease
Vision loss; Typically painless Progressive Bilateral asymmetric Headache possible
Anything to Anterior to chiasm and LGN
optic atrophy and contralateral APD possible
Posterior the LGN,
no optic atrophy and RAPD.
Post-Chiasmal Disease
Homonymous: nasal VF of one eye and temporal VF of fellow eye
Congruous: nasal and temporal defects closely resemble each other
Decreased VA not common unless lesion also involves optic nerve or occipital lobes
Usually due to cardiovascular disease (stroke)
Optic Tract Lesions
Tumors
Ischemic stroke
Aneurysms of superior cerebellar or PCA
Lesions of optic radiations
Vascular occlusions (common causes) Primary & secondary tumors Trauma Incomplete incongruous quandranopsias Neurologic deficits predominate
Neurologic symptoms predominate
Temporal Lobe Lesions
Seizures
Hemiparesis (loss of motor control )
Hemisensory loss (loss of sensation)
Aphasia
Neurologic symptoms predominate
Parietal Lobe Lesion
Hemiplegia (paralysis of one side of the body.)
Hemisensory loss
Visual neglect
Aphasia
Lesions of the visual cortex
will Not have any neurologic defect .
Calcarine cortex lesions;
always due to stroke,
completely Congruous
no neurological deficits
+/- macular sparing
