Localizing Opthalmologic Disease

Question 1

• Ipsilateral “down and out” deviation due to unopposed lateral rectus and superior oblique contraction; may cause diplopia.
• Pupil is fixed and dilated secondary to paralysis of pupillary sphincter

Answer 1

Cranial nerve 3	
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 Uncal herniation
Diabetes mellitus
Berry aneurysm

Question 2

Paralysis of superior oblique muscle

Ipsilateral upward eye deviation at rest, which becomes more pronounced with contralateral gaze

Answer 2

Cranial nerve 4

Question 3

Paralysis of ipsilateral lateral rectus muscle
Inward deviation of ipsilateral eye at rest
Loss of abduction in ipsilateral eye

Answer 3

Cranial nerve 6

Question 4

Inability to adduct the eye with horizontal gaze testing

Answer 4

Multiple Sclerosis

Question 5

Typically due to compression from a pituitary adenoma or craniopharyngioma
Bitemporal hemianopia → loss of peripheral vision

Answer 5

Optic chiasm

Question 6

Complete loss of vision in the ipsilateral visual field

Answer 6

Optic nerve

Question 7

Contralateral loss of either the right or left halves of the visual field in both eyes

Answer 7

Optic tract

Question 8

Associated with pineal gland tumors

Vertical gaze palsy

Answer 8

Superior colliculus

- Parinaud syndrome

Question 9

Ipsilateral symptoms
Ptosis
Anhidrosis
Miosis

Answer 9

Superior cervical ganglion	
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Horner syndrome
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Associated with Pancoast tumors and stroke (anterior inferior cerebellar artery and posterior inferior cerebellar artery)