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0
Q

Ddx light-near dissociation

A
  1. Dorsal midbrain syndrome 2. Adies pupil 3. Argylle robertson sx
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1
Q

What are the 4 findings in dorsal midbrain syndrome?

A
  1. Impaired upgaze 2. Bilat lid retraction (colliers sign) 3. Headache 4. Dizziness
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2
Q

Ddx cn3 palsy

A

1.Myasthenia (can cause any cranial neurop but never involves pupil) 2. Ischemia 3. Trauma to frontal bone 4. Ms 5. Tumor

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3
Q

Whats a cecocentral scotoma on vf mean?

A

Optic nerve disorder eg compressive toxic optic neuritis

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4
Q

Arcuate scotoma mean

A

Nfl defect along horiz raphe = glaucoma

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5
Q

Whats a cecocentral scotoma?

A

Blind spot connect to central fixation

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6
Q

What does homonomous defect mean?

A

Is it on the same side of the vertical

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7
Q

What does it mean if the vf defect is vertical?

A

Its at the chiasm or behind The more congruous the defect the further back it is

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8
Q

Bitemporal hemianopsia what should you ask about?

A

Galactorrhea Menstrual irregulation Weight fluctuation Get mri with gad

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9
Q

Whats the ddx of a central scotoma on vf?

A

Csr Amd Toxic on Lebers hereditary on Infiltrative

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10
Q

Pie in the sky defect Where localize to? What to order?

A

Temporal lobe (meyer loop) Order mri w and wo gad to look for tumor or stroke

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11
Q

Bulateral homonmous inferior quadrantopsia Where localize to? What test to do?

A

Parietal lobe Check okn drum bc it tests smooth pusuit and if you lose parietal lobe you lose smooth pursuit

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12
Q

What does homonomous mean?

A

Vf in Both eyes Occurs on same side of the vertical

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13
Q

Where does arcuate or altitudnal defects localize to?

A

Optic nerve

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14
Q

What does congruity mean?

A

How similar the two sides are. The more posterior you get in the brain the more congruous the defects are

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15
Q

Atropine poisoning symptoms

A

Anti cholonergic so acts like a sympathetic drug Big pupils Decr Salivation Hot as a hare Dry as a bone Mad as a hatter

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16
Q

Mg

A

Mg no ach Give tensilon = ach If adverse rxn Give atropine (anti ach)

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17
Q

Whats the rx for atropine toxicity?

A

Tensilon (physostigmine)

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18
Q

What does organophosphate poisoning look like?

A

Organophosphate are anti ach Just like atropine Can also look like mg (no ach) So give tensilon

19
Q

Ddx mg

A

Organophosphate poisoning Attopine poisoning Lambert eaton(no release of ach into the synapse) Miller fisher (varient of guillien barre that starts w eyes) Guillian barre Cpeo (mitochondrial do) Oculopharengeal muscular dystrophy Venoms Botulism poisoning- toxin prevent release from presynaptic terminal (likr lambert eaton)

20
Q

Rx of mg

A

Mestinon 60 or 180 Prednisone Thymectomy

21
Q

How do you work upmg?

A

Tensilon test (10mg) Have atropine ready Check anti ach ab Check anti musk ab Cxr to look for thymoma Ro other autoimmune do

22
Q

What cancer is lambert eaton ass w?

A

Small cell lung cancer

23
Q
A

left homonomous inferior quadrantopia, R parietal defect

24
Q
A

ALTITUNAL DEFECT

could be optic neuritis or NAION

25
Q
A

CENTRAL SCOTOMA OU

ddx:

csr

toxic optic neuropathy

amd

lebers hereditary optic neuropathy

infiltrative

26
Q
A

R meyers loop in temporal lobe

get mri w and wo gad

27
Q
A

bitemporal defect is chiasmal lesion until proven otherwise

28
Q
A

VF defects in both eyes densist part respects the horizontal midline- could be occipital lobe or could be paracentral scotoma

29
Q
A

inferior altitudnal defect (altitudnal defects do NOT cross the horizontal

30
Q
A

Right superior homonomous hemianopsia involving superior quadrant

31
Q
A

unilateral right central scotoma- either a problem with the macula or ON

32
Q
A

unilateral right VF defect with central sparing could be functional tunnel vision, if this were bilateral would think RP. can check for fxl vision loss w tangent screen

33
Q
A

clover leaf pattern

34
Q
A

bilateral paracentral scotoma OR Right homonomous incongruous hemianopia from L parietal or occipital lesion

35
Q
A

junctional scotoma, think about mass in chiasm

36
Q
A

defects ou either bitemporal hemianopia or a jxnal scotoma

37
Q
A

Left parietal lobe lesion

38
Q
A

left homonomous congruous defects could be occipital lesion b/c so congruous

39
Q
A

Right temporal lobe lesion

40
Q
A

left homonomous incongruous hemianopsia, must be retrochiasmal right tract lesion

check an apd left eye and for a lesion in the right tract

41
Q
A

enlarged BS OU or possibly bitemporal hemianopsia, check to see if nerves are swollen, if so it could be enlarged blind spot

42
Q
A

non homonomous, not bi-temporal, could represent superior altitudnal defect- sequential optic neuropathy

44
Q

what is this?

A

pituitary adenoma

45
Q

whats this?

A

midbrain tumor

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