Lect 11 optic neuropathies 2

Question 1

(T/F) NAION (non-arteric anterior ischemic optic neuropathy) is a vascular insult to pre-laminar and retro-laminar optic nerve

Answer 1

true (it is ischemic, however, not inflammatory)

Question 2

Which one of the following is NOT true regarding NAION?

a) ischemia to SPCA results in decreased optic nerve perfusion
b) the most common VF defect associated with NAION is central scotoma
c) NAION is more prevalent in males
d) The optic nerve appearance shows hyperemic edema, flame hemorrhages, and may/may not have a macular star
e) rapid onset of VA/VF loss, typically upon waking up
f) positive RAPD

Answer 2

b) the most common VF defect associated with NAION is central scotoma (FALSE, its altitudinal)

• altitudinal=62%
• inferior=47%
• central scotoma=21%

Question 3

(T/F) AION (arteric ischemic optic neuropathy) is an inflammation of elastic tissue in the arterial walls that leads to vessel occlusion

Answer 3

true (predilection for temporal, vertebral, opthalmic, and posterior ciliary arteries)

Question 4

Which one of the following is NOT true regarding AION?

a) Pt has extensive hemorrhages and no cotton wool spots
b) symptoms: jaw claudication, scalp tenderness, pt may have a bulging ropey looking vessel popping out of their forehead
c) AION is more prevalent in females
d) 75% bilateral, fellow eye involved in 1-2 days
e) treatment is stat IV steroids followed by oral steroids

Answer 4

a) Pt has extensive hemorrhages and no cotton wool spots (FALSE, pt has no hemorrhages and extensive cotton wool spots

Question 5

(T/F) PION (posterior ischemic optic neuropathy) is an insult to the retro-laminar optic nerve blood supply

Answer 5

true (PION is usually associated with postsurgical: cardiac, spinal, thoracic, and abdominal but can also be spontaneous: vasculitis, atherosclerosis, and radiation)

Question 6

Which one of the following is NOT true regarding (PION) Posterior Ischemic Optic Neuropathy?

a) a post-surgical condition where pt wakes up to discover poor VA in one/both eyes
b) initially optic disc is normal but pallor develops in 4-6 weeks
c) RAPD
d) If RAPD is absent and both pupils are briskly reactive then suspect bilateral posterior cerebral artery infarction aka cortical blindness
e) all of the above are true

Answer 6

e) all of the above are true

Question 7

Which one of the following is NOT true regarding Diabetic Papillopathy?

a) Visual fields reveals an enlarged blind spot
b) it may be a mild form of AION
c) it can be unilateral or bilateral
d) diabetic retinopathy is usually present
e) all of the above are correct

Answer 7

b) it may be a mild form of AION (FALSE, it may be a mild form of NAION)

Question 8

Which one of the following is NOT true?

a) Papilledema is optic nerve edema caused by raised intracranial pressure
b) elevated CSF is transmitted to tissue fluid between axons and ONH
c) CSF is present in ventricles, central canal of spinal cord, and subarachnoid space
d) CSF drains via facial veins

Answer 8

d) CSF drains via facial veins (FALSE, it drains via internal jugular veins)

Question 9

Which one of the following is NOT a finding of papilledema?

a) Paton’s folds
b) macular edema
c) macular star
d) cotton wool spots
e) ONH and pappillary hemes

Answer 9

d) cotton wool spots

Question 10

Which one of the following is NOT a feature of papilledema?

a) VA loss due to macular edema
b) unilateral
c) enlarged blind spot in VF’s
d) spontaneous venous pulsation is absent
e) headache symptoms worsen with valsalva maneuver

Answer 10

b) unilateral (FALSE, bilateral)

Question 11

What are the 2 common mechanisms of increased ICP?

Answer 11

1) increased brain volume (tumor, hemoohage, abcess)
2) decreased CSF drainage (meningitis, hydrocephalus, subarachnoid heme, venous outflow obstruction)

increased CSF production is rare. decreased skull volume is rare

Question 12

Pseudotumor cerebri is also known as…

Answer 12

idiopathic intracranial hypertension (IIH)

Question 13

Which one of the following is NOT a dandy criteria of IIH?

a) signs/symptoms of increased ICP
b) Lp opening pressure greater than 25cmH2O with normal CSF composition
c) abnormal MRV
d) no localizing neurological signs except CN 6 palsy
e) no evidence of intracranial mass
f) pt is awake and alert

Answer 13

c) abnormal MRV (FALSE, normal MRV)

Question 14

Describe the type of pt that may develop pseudotumor cerebri and the medications that can cause it

Answer 14

Forty, fat, fertile, females eat Tons of Pasta.

Tetracycline
Oral Contraceptives
Nalidixic acid
Steroids

Phenytoin
Accutane
Sulfa
Tamoxifen
A-vitamin A

Question 15

(T/F) In pt’s with IIH, a 6% reduction in weight loss results in papilledema resolution

Answer 15

true

Question 16

(T/F) In unilateral optic nerve edema, a possible etiology is papillophlebitis. idiopathic inflammation of peripapillary retinal vessels

Answer 16

true