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OD 3 - Neurological Disorders > Lectures 1 - 5 > Flashcards

Lectures 1 - 5 Flashcards

1
Q

What does gradual onset make you think?

A

Inherited or compressive

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2
Q

What does sudden onset make you think?

A

Ischemic, inflammatory or infectious

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3
Q

What does afferent mean?

A

Toward the brain

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4
Q

What does efferent mean?

A

Away from the brain

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5
Q

What age group do you think of when you are considering congenital lesions?

A

Children

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6
Q

What age group do you think of when you are considering degenerative or vasculopathic lesions?

A

Older adults

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7
Q

What age groups make you think of neoplastic disorders?

A

Children (Craniopharyngioma)

Adults (Pituitary Adenoma)

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8
Q

What are the critical components of a neuro-ophthalmic history? (10)

A 
CC
Detail the Problem
Temporal Profile of Symptoms
Associated Symptoms
Past Neurological History
Neurology Systems Review
Past Medical History
Family History
Social History
Special Considerations in Children (Pregnancy, Birth, Milestones)
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9
Q

When detailing the problem for afferent and efferent issues what are some unique questions you would ask to differentiate between the two?

A

Afferent: nasal, temporal, superior, inferior field of vision. Degree of loss.
Efferent Constant or Variable/Transient

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10
Q

What sort of disease process are you thinking of when the pattern of symptoms are described as acute w/ eventual plateau?

A

Vascular/Inflammatory

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11
Q

What sorts of disease processes are you thinking of when the pattern of symptoms is described as episodic?

A

Migraine, carotid disease, seizure disorder

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12
Q

What sort of disease process are you thinking when the degree of recovery is transient

A

Elevated ICP, vascular

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13
Q

What sort of disease process are you thinking when status gets worse over time then plateaus?

A

Inflammatory

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14
Q

What kind of recovery do you expect when a patient has a lesion due to ischemia?

A

Acute loss w/ little recovery

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15
Q

What kind of disease progression do you expect when your patient has a compressive lesion?

A

Gradual worsening

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16
Q

What are the major functions of the frontal lobe?

A

Primary motor cortex
Personality, behavior, emotion
Judgement, planning, problem solving
Intelligence, concentration, self-awareness
Broca’s area: expressive language
FEF: saccades, voluntary eye movement; communicates w/ EOMs via PPRF

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17
Q

What are the major functions of the parietal lobe?

A

Primary sensory cortex
Interpret visual and spatial information
Interpret language and words
Dominant lobe (left): calculation, writing, left-right orientation, finger recognition
Non-dominant lobe: integrates contralateral side of body with environment (left sided neglect)
Connect somatosensory, auditory and visual input

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18
Q

What are the major functions of the temporal lobe?

A

Understanding language (Wernicke’s speech area), hearing, memory

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19
Q

What is the major function of the occipital lobe?

A

Vision

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20
Q

What percentage of the total neurons in the brain pass through the cerebellum?

A

50%

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21
Q

What are the major parts of the diencephalon?

A

Thalamus & Hypothalamus

& the pineal gland

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22
Q

What nuclei are contained in the midbrain?

A

CN III and CN IV

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23
Q

What sensory and motor nuclei lie within the pons?

A

CN V, VI, VII, & VIII

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24
Q

What are the major components of the sympathetic nervous system pertaining to vision?

A

Any lesion to the sympathetic chain will affect your ability to dilate.
Pre-ganglionic : T1-2
Synapse: Cervical Sympathetic Ganglia
Postganglionics: Peri-arterial plexus along ICA and ECA

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25
Q

What are the major components of the parasympathetic nervous system pertaining to vision?

A

Preganglionics: CN III, VII (& IX, X)
Synapse: 4 cranial ganglia (ciliary & pterygopalatine) or directly on target glands
Postganglionics (Distributed via branches of CN V)

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26
Q

Describe the anatomy of CN I.

A

Olfactory Nerve
Not a true nerve
exits cranium via perforation in the cribriform plate
Special afferent fibers only

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27
Q

Describe the anatomy of CN II.

A 
Optic Nerve
Not a true nerve
Exits cranial cavity via optic canal
Carries axons of ganglion cells in the retina
Special afferent fibers only
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28
Q

Describe the anatomy of CN III.

A

Oculomotor Nerve
Exits cranial cavity via superior orbital fissure
Mixed cranial nerve (GE & VE)

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29
Q

Describe the anatomy of CN IV.

A

Trochlear
Innervates superior oblique
Originates in dorsal aspect of midbrain (on CN to cross over)
Exits cranial cavity via superior orbital fissure
General efferent only

30
Q

Describe the anatomy of CN V.

A

Trigeminal
Mostly sensory
Some GSE fibers
Suspends 4 sympathetic ganglia (ciliary, pterygopalatine, otic, submandibular)
Carries hitchhiking fibers
Exits from the Pons
3 Divisions (Ophthalmic, maxillary, mandibular)

31
Q

Describe the anatomy of CN VI.

A

Abducens
Innervates lateral rectus
Exits brainstem at junction of pons and medulla
Exits cranial cavity via superior orbital fissure
General efferent only

32
Q

Describe the anatomy of CN VII.

A

Facial Nerve
GE, VE, SA (ant. 1/3rd of tongue)
Longest intraosseous course

33
Q

Describe the anatomy of CN VIII.

A

Vestibulocochlear
Leaves brainstem lateral to CN VII at CPA
Exits cranial cavity through internal acoustic meatus
Does not leave the skull
Innervates inner ear structures
Special afferent fibers only

34
Q

Describe the anatomy of CN IX.

A

Glossopharyngeal
Leaves brainstem from lateral aspect of upper medulla
Exits cranial cavity via jugular foramen
VE, VA, GA (post 1/3rd of tongue)

35
Q

Describe the anatomy of CN X.

A

Vagus
Leaves brainstem lateral to CN IX in the upper medulla
Exits cranial cavity via jugular foramen
GE, VE (to all organs below neck minus adrenal)

36
Q

Describe the anatomy of CN XI.

A

Spinal Accessory Nerve
Innervates trapezius & sternocleidomastoid
GE only
Originates outside the skull in the upper spinal cord between C1 and C5
Enters skull via foramen magnum, exits skull via jugular foramen

37
Q

Describe the anatomy of CN XII.

A

Hypoglossal
Innervates the tongue
Leaves the cranial cavity via hypoglossal canal in the occipital bone
GE only

38
Q

What are the critical components of the neuro-ophthalmic exam for the afferent visual system?

A

VA
Contrast Sensitivity
Color Vision
VF

39
Q

What are the critical components of the neuro-ophthalmic exam for the efferent visual system?

A

Pupils
Eyelids
EOMs
Facial Nerve Function

40
Q

How do you test CN I (Olfactory Nerve)?

A

Test each nostril separately with coffee or perfume

41
Q

How do you test CN II (Optic Nerve)?

A

VA, color vision, VF, pupils

42
Q

How do you test CN III (Oculomotor Nerve)?

A

EOMs (SR, MR, IR, IO, LPS), pupils

43
Q

How do you test CN IV (Trochlear)?

A

EOMs (SO)

44
Q

How do you test CN V (trigeminal)?

A

Sensory: facial sensation in each area, corneal blink reflex
Motor: ask pt to clench teeth while you palpate master and pterygoid, have patient move jaw against resistance from your hand

45
Q

How do you test CN VI (Abducens)?

A

EOMs (LR)

46
Q

How do you test CN VII (facial)?

A

Motor: eyelid closure, forehead wrinkling, smiling, cheek puffing, whistling
Lacrimation: Shirmer Testing
Taste

47
Q

How do you test CN VIII (Vestibulocochlear)?

A

White Noise Tests (Rinne Test, Weber Test)

48
Q

How do you test CN XI (Spinal Accessory Nerve)?

A

Head and shoulder elevation

49
Q

How do you test CN IX (Glossopharyngeal) and X (Vagus)?

A

Check gag reflex

50
Q

How do you test CN XII (Hypoglossal)?

A

Tongue protrusion (lick the wound)

51
Q

What are the key components of a neurological exam?

A

Mental Status Evaluation
Cranial Nerve Assessment
Examination of Arms and Legs

52
Q

What does the hill of vision?

A

As you get closer and closer to the fovea from the periphery your sensitivity increases until you reach the peak at the center of the fovea

53
Q

Where is the physiological blind spot?

A

15 degrees temporal to point of fixation, 1.5 degrees below the horizontal meridian

54
Q

In what type of perimetry do patients with neurological diseases tend to do better at?

A

Kinetic perimetry (octopus)

55
Q

What other part of the visual pathway will be involved when a pituitary tumor pushes on a pre-fixed chiasm?

A

Optic tract first

56
Q

What other part of the visual pathway will be involved when a pituitary tumor pushes on a post-fixed chiasm?

A

Optic nerve first

57
Q

What is the visual pathway extending from the retina to the occipital cortex?

A

Retinal ganglion cells > Optic nerve > Optic chasm > Optic tract > Lateral Geniculate Body > Optic Radiations > Visual Cortex

58
Q

What does a depression in a VF mean?

A

Generalized reduction in retinal sensitivity

59
Q

What does a scotoma mean?

A

A focal area of reduced sensitivity surrounded by an area of normal sensitivity

60
Q

What are the patterns of VF loss when there is a lesion to the optic nerve?

A

Central, centro-cecal, arcuate, altitudinal, enlarged blind spot, diffuse

61
Q

What kind of VF loss do you expect with Anterior Chiasmal Syndrome?

A

Ipsilateral central scotoma, contralateral superior temporal defect

62
Q

What kind of VF loss do you expect with Posterior Chiasmal Syndrome?

A

Central bitemporal hemianopia defects (nasal macular fibers)

63
Q

What kind of VF defect do you expect with Middle Chiasmal Syndrome?

A

Bitemporal hemianopia, bilateral optic atrophy

64
Q

What kind of VF defect do you expect with Lateral Chiasmal Lesion?

A

Binasal hemianopia, bilateral optic atrophy

65
Q

What kind of VF defect do you expect to find with an optic tract lesion?

A

Congruous hemianopia

66
Q

What kind of VF defect do you expect to find with a Lesion of the Optic Radiations?

A

Incomplete incongruous quadranopsia but neurological deficits predominate

67
Q

What kind of VF defect do you expect to find with a temporal lobe lesion?

A

Pie in the Sky

68
Q

What kind of VF defect do you expect to find with a parietal lobe defect?

A

Pie in the floor

69
Q

What kind of VF defect do you expect to find with a middle cerebral artery infarct to the visual cortex?

A

Congruous homonymous hemianopia with macular sparing

70
Q

What kind of VF defect do you expect to find with a posterior cerebral artery infarct to the visual cortex?

A

Congruous homonymous macular defect

OD 3 - Neurological Disorders (2 decks)

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