Neuro Eye Diseases

Question 1

Cerebral palsy

-Types

Answer 1

Spastic 80%

• Decreased spontaneous movements
• Increased muscle tone.
• Commando crawl, delayed walking
• Can be diplegia, hemiplegia, or quadriplegia

Dyskinetic 20%

• Problems controlling limb movement.
• Signs: Hypotonia as infants.
• Speech involvement
• difficulty feeding

Ataxic
-Balance and coordination probs

Mixed

Question 2

Associated medical conditions with cerebral palsy

Answer 2

Seizures 30%
Mental retardation 24%
Hearing loss
Speech probs

Damage to the brain, not the ON or eye

Question 3

Vision problems in cerebral palsy

Answer 3

Decreased acuity. 
Strab in 40-70% 
ET is more common, except XT in spastic form. 
Hyperopia > myopia 
accommodation dysfunction 60%

strong color preference
Movement to see objects

Question 4

Nystagmus

• Document what
• What is conjugacy
• 2 types

Answer 4

Unilateral vs bilateral
Amplitude
frequency
Conjugacy- opposite or same direction?

Jerk- fast and slow phase
Pendular- Equal velocity in both directions

Question 5

Neurologic signs/symptoms of nystagmus

Answer 5

• Anti epileptic drugs can cause.
• Seizures
• Poor balance
• Vomiting
• Dizzy, HA

Question 6

Infantile nystagmus

Answer 6

Onest at 2-4 months
Motor forms- efferent pathway disorder, genetic,
Sensory- ON anomaly, ocular albinism, cataracts. Usually pendular.
May improve with gaze.
Latent

Worsens at distance, better with convergence at near.
Null point can be found with head tilt. Can dx base out to encourage convergence and dampen.

Question 7

Congenital esotropia syndrome

Answer 7

Pt with congenital nystagmus may have associated ET.

Question 8

Acquired nystagmus

Answer 8

Pendular, jerk, see saw (one eye elevates/inrorts, other depresses/extorts. Rare. Lesion in midbrain)

Downbeat- cerebellar lesion

Upbeat- cerebellum, medulla, midbrain lesion.

Spasmus Nutans- head tilt, head nodding, and asymmetric/monocular nystagmus.

Question 9

Aquired nystag- spasmus nutans. Triad. Resolves when?

Answer 9

Head tilt- torticollis
Head nodding
Monocular nystagmus.

Resolves by 5 years. Benign.

Question 10

In young children, monocular nystagmus can be caused by

Answer 10

Tumors of the optic chasm and the third ventricle. Can be difficult to distinguish from spasmus nutans. MRI or referral is necessary

Question 11

Nystagmus exam

Answer 11

VA. Frosted occlude or high plus lenses.
Motilities
Pupils
ON assessment with dilation and color vision.
OKN
Consider MRI

Question 12

Causes of ON edema and pseudo edema

How to differentiate

Answer 12

Edema:
Papilledema with raised ICP
-hydrocephalus, tumor or infection, IIH/pseudotumor cerebra.

Symptoms: Nausea, vomiting, HA, double vision

Pseudo:
Drusen, crowded nerves.
Looks bad, sees good.

Question 13

Papilledema

Answer 13

ON swelling WITH raised ICP.

Can have retinal folds

Early signs: Blurry disc margins. Absent SVP.
Late signs- retinal hemorrhages and exudate

Question 14

Pseudotumor cerebrii/IIH

Primary and secondary causes

Answer 14

Primary- Could be due to PCOS.

Secondary- meds. Tetracyclines.
Addisons disease
Turner
Down syndrome

Question 15

Streff Non-Malingering syndrome

Answer 15

No obvious pathology 
Stress theory
Decreased VA OU at distance and near. 
Abnormal color vision and visual fields. 
Low plus refraction