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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > ND - CNS Disorders and Cranial Tumours - Week 9 > Flashcards

ND - CNS Disorders and Cranial Tumours - Week 9 Flashcards

1
Q

What is the general prevalence of dementia, and its prevalence >80yoa?

A

5% increasing to 20-40%

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2
Q

What are the two kinds of dementia causes and percentage of cases.

A

Degeneration 55%

Infarct 45% of the limbic system

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3
Q

What is the most common form of degeneration type dementia?

A

Alzhiemers disease

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4
Q

List three causes of dementia in young people. Is it common?

A

Creutzfeldt-jakob disease (prion)
Picks disease (hereditary)
Alcoholic toxicity

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5
Q

What is the average prognosis for dementia?

A

From diagnosis to death is ~8 years

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6
Q

What is the limbic system and what does it mediate (3)?

A

A group of interconnected nuclei that mediates emotions, learning, and memory

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7
Q

What forms neurofibrillary tangles in alzhiemers disease? What do these proteins normally do?

A

Microtubule protein tau binds tubules in the normal brain

In AD, phosphorylation produces free tau, resulting in tubule breakdown resulting in tangles

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8
Q

Describe how amyloid plaques form in AD. What is it a byproduct of? Where does it accumulate and hat does it result in?

A

B-amyloid is a byproduct of neural tube breakdown
Accumulates in the ECM, forming plaques
It is neurotoxic, resulting in CNS apoptosis

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9
Q

What ultimately happens with AD?

A

The brain atrophies

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10
Q

List three CNS effects of limbic system degeneration in AD.

A

Cortical atrophy
Shrinkage of brain mass
Enlarged ventricles (in the brain)

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11
Q

List a PNS effect of limbal system degeneration in AD and why.

A

Apoptosis/glaucoma due to decreased bDNF

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12
Q

What is the outcome of limbal system loss in AD (2)?

A

Dementia (memory/speech)

Visual processing loss ± glaucoma

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13
Q

Are there any ocular signs of AD? Explain (4).

A 
Some research indicates there is
Retinal nerve fibre layer thinning
Resence of B-amyloid plaques in the retina
Retinal vessel calibre changes
Retinal blood flow changes
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14
Q

Where does myelination first begin in the visual system and where does it proceed to and stop?

A

Starts 5th month gestation in the LGN, proceeds to the eye

Stops at the lamina 6th month

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15
Q

How does a myelinated retina appear (2)? What happens if an individual with a myelinated retina has MS?

A

Feathery white appearance
Distinct fibres visible
May disappear with MS

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16
Q

What is the primary function of myelin?

A

To facilitate inter-nodal axonal conduction

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17
Q

List three causes of demyelination and the most common.

A

Multiple sclerosis (most common)
Toxicity (CO problems)
Inflammation

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18
Q

In what percentage of MS cases is optic neuritis a presenting sign? What percentage of MS cases have optic neuritis?

A

~20% optic neuritis as the presenting sign

~85% of MS cases have optic neuritis

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19
Q

What are two presentations of optic neuritis?

A

Visible at the lamina called papillitis

Retrobulbar to orbit called retro-bulbar neuritis

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20
Q

What is an ocular sign of retrobulbar neuritis?

A

No obvious ophthalmic signs

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21
Q

What can be seen with OCT analysis of retrobulbar neuritis (2)?

A

Loss of RNFL and optic atrophy

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22
Q

What can form in regions of dense inflammation in retrobulbar neuritis (2)?

A

Scarring and plaque formations

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23
Q

List 4 eye involvements (symptoms) of retrobulbar neuritis.

A

Distorted/loss of vision, colour vision
Abnormal visual evoked response
Eye movement anomaly or diplopia

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24
Q

List 5 systemic problems of MS.

A 
Muscle symptoms
Bowel/bladder symptoms
Numbness/tingling/pain
Decreased attention span/poor memory
Fatigue
25
Q

What is required to identify multiple sclerosis?

A

Multiple lesions over multiple episodes (MRI)

26
Q

What is a consequence of expansive disorders?

A

Raised intracranial pressure

27
Q

List 5 common diseases associated with raised intracranial pressure.

A 
Uncontrolled systemic hypertension
Cranial mass
Pseudotumour cerebri
Subarachnoid haemorrhage
Intracerebral haemorrhage
28
Q

Describe the mass effect.

A

When a space occupying lesion expands in the confines of a fixed volume

29
Q

What does raised intracranial pressure result in (3)?

A

Pain (headache)
Axoplasmic stasis
Vascular compromise

30
Q

List 7 neurologic signs of raised intracranial pressure.

A

Severe/different CONSTANT headaches
Rigidity about the neck with loss of forward flexion
Gait problems (unsteady)
Projectile vomit with no nausea
Hemi-paresis
Reduced state of alertness
Worstening symptoms ith straining, valsalva, posture change

31
Q

List 5 ocular signs of raised intracranial pressure.

A 
Photophobia
Short-lived visual disturbance, blur, or loss (5-30 secs)
Diplopia
Pupil abnormality
Papilloedema
32
Q

What is the cause of ocular signs manifesting with raised intracranial pressure?

A

Due to transmission of intracranial pressure down the ONH sheath to the lamina cribrosa

33
Q

What two things would make one highly suspicious of raised intracranial pressure?

A

Papilloedema ith at least one other neurological sign

34
Q

How are intracranial pressure abnormalities diagnosed?

A

Lumbar puncture

35
Q

Within what timespan of raised intracranial pressure can papilloedema occur? hat is it typically?

A

Can occur within 24h

Typically 3-7 days

36
Q

Is spontaneous venous pulsation a reliable rign of raised intracranial pressure?

A

No

37
Q

Is papilloedema always bilateral? Explain.

A

Yes, but often asymmetrical

38
Q

Describe foster-kennedy syndrome and what it is due to.

A

Optic atrophy in one eye due to crunch and papilloedema in the other eye due to mass effect

39
Q

How is papilloedema caused by raised intracranial pressure?

A

Transmission of intracranial pressure along the sub-arachnoid space

40
Q

With papilloedema, describe the following:
Pole where it is most marked
Blood vessels at the disc (2)
Vessels in general
Papilla
In addition to this, list three three features you would see.

A 
Most marked at the inferior pole
Disc hyperaemia and buried blood vessels
Venous engorgement
Papilla swelling
Peripapillary haemorrhage
Cotton wool pathes
Retinal or choroidal folds
41
Q

What are cotton wool spots?

A

NFL infarcts

42
Q

How many types of papilloedema can be seen and when do they manifest? What does the type depend on (2)?

A 
Long term (>3 months), 2 types can be seen
Type depends on the level of vascular compromise and shunt development
43
Q

Describe compensated papilloedema (shunt, venous flow, axoplasmic stasis).

A

Shunt established, venous flow compromised but axoplasmic stasis still present

44
Q

What appearance does compensated papilloedema have (2)?

A

Clean appearance with gross intravitreal swelling of the ON

45
Q

Describe non-compensated papilloedema (shunt)?

A

Shunts not established

46
Q

What appearance does non-compensated papilloedema have (3)?

A

Very dirty appearance with haemorrhages and cotton wool spots

47
Q

What is pseudotumour cerebri and who does it typically affect?

A

False brain tumour, typically affecting premenopausal obese women

48
Q

What are the signs of pseudotumour cerebri (2)?

A

Signs as per papilloedema, but all investigations fail to find a cause

49
Q

What kind of diagnosis is pseudotumour cerebri?

A

Diagnosis by exclusion

50
Q

Does pseudotumour cerebri present with many neurological signs?

A

Few neurological signs

51
Q

What are the symptoms of pseudotumour cerebri?

A

As per papillodema

52
Q

What percentage of patients with pseudotumour cerebri have severe vision loss?

A

2%%

53
Q

What cranial nerve involvement and hat ocular problems are common with pseudotumour cerebri?

A

CN6 involvement and BV problems

54
Q

Why do aneuryms and subarachnoid haemorrhages often involve vision or visual pathways?

A

Due to the location of major cerebral blood vessels

55
Q

What is an aneurysmal rupture considered?

A

Neurological emergency

56
Q

When do symptoms of rupture occur before and after rupture (in terms of percentages for each)?

A

After rupture - 90%

Before rupture due to growth/compression - 10%

57
Q

What can symptoms of an aneurysm give prodrome for?

A

Impending aneurysmal rupture

58
Q

List three typical symptoms of aneurysms.

A

Severe headaches
Visual disturbances
± neurological symptoms

59
Q

List 7 symptoms of a subarachnoid haemorrhage.

A

Recent onset of constant or severe headache that do not comply with recognised patterns (thunderclap/migraine)
Short-lived losses of visiond, blur or visual field
Photophobia
Rigidity about the neck with loss of forward flexion
Papilloedema
Intraorbital haemorrhage
Gradual ON atrophy with/without cupping
Changes in consciousness/alertness

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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