Lecture 14: Neuro-opthalmology

Question 1

What is pupilodeama?

Answer 1

When there is BILATERAL optic disc swelling

Question 2

What is miosis?

Answer 2

Small pupil

Question 3

What is large pupil?

Answer 3

Mydriasis

Question 4

What is aniscoria?

Answer 4

Difference in pupil size

Question 5

What are the pupil reflexes?

Answer 5

• Light reflex – direct/consensual
• Near reflex – miosis / accommodation / convergence
• Relative afferent pupil defect
• Pathologic pupil defects

Question 6

What is the relative afferent pupil defect?

Answer 6

Can indicate optic nerve compression

• Completed by swinging bright light in dim room 30cm from face, looking for differences in dilation to light

Question 7

What are some surrogates for the RAPD?

Answer 7

Brightness sense good eye is worth 100% brighteness, whats the other eye suggesting

Red perception

Question 8

Whats horners triad?

Answer 8

• Ptosis
• Miosis
• Anhidrosis

Question 9

How do you test for horners?

Answer 9

Topical cocaine: Horners pupil wont dilate b/c lack of NE, other will because uptake blocked.

Topical aproclonidine (Alpha agon): Dilates affected pupil

Question 10

What can cause horners?

Answer 10

• Brainstem disease
• Spinal Cord tumour
• Carotid dissection
• Painful Horners
• Tumour at lung apex
• Neck lesions

All impact the SNS

Question 11

What are the signs of an occulomotor nerve palsy?

Answer 11

• Ptosis (partial or complete)
• Pupil dilation
• Limitation of upgaze/downgaze
  and adduction

Question 12

What are the causes of a CN3 palsy?

Answer 12

• Intracranial aneurysm
• Need MRI/MRA
• Giant cell arteritis
• Over the age of 60
• Associated with systemic constitutional symptoms
• Do ESR/CRP
• Temporal artery biopsy is gold standard

Question 13

Describe the visual pathway

Answer 13

1. Optic Nerve
2. Chiasm
3. Optic tract
4. Lateral geniculate
   nucleus
5. Optic radiation
6. Visual cortex

Go through some examples to work out lesion location and understand hemianopias