Neuro IX Flashcards
Central retinal artery occlusion presentation
acute, painless monocular vision loss.
central retinal artery occlusion findings
1) Retina cloudy with attenuated vessels.
2) “cherry-red” spot at fovea (center of macula)
central retinal artery occlusion management
Evaluate for embolic source.
Embolic sources of central retinal artery occlusion
1) carotid artery atherosclerosis
2) cardiac vegetations
3) PFO
retinitis pigmentosa presentation
Painless, progressive vision loss beginning with night blindness (rods affected first)
retinitis pigmentosa etiology
inherited retinal degeneration.
retinitis pigmentosa findings
1) Bone spicule-shaped deposits around macula.
retinitis pathophys
retinal edema and necrosis leading to scarring.
retinitis causes
1) often viral (CMV, HSV, VZV)
2) bacterial
3) parasitic
retinitis association
immunosuppression
papilledema pathophys
Optic disc swelling (usually bilateral) due to increased ICP.
papilledema fundoscopy findings
Enlarged blind spot + elevated optic disc with blurred margins.
Miosis pathway
1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III.
2nd neuron: short ciliary nerves to pupillary sphincter muscles.
pupillary light reflex pathway
Light in either retina sends a signal via CN II to pretectal nuclei in midbrain that activates bilateral Edinger-Westphal nuclei; pupils contract bilaterally.
Mydriasis pathway
1st neuron: hypothalamus to ciliospinal center of Budge (C8-T2)
2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex, subclavian vessels)
3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscles. Sympathetic fibers also innervate smooth muscle of eyelids (minor retractors) and sweat glands of forehead and face.
marcus gunn etiology
Due to optic nerve damage or severe retinal injury. Decreased bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye.
Horner syndrome pathophys
lesion of spinal cord above T1 leads to sympathetic denervation.
Horner syndrome pathway
1st order neuron from hypothalamus to synapse in lateral horn
2nd order neuron from lateral horn to superior cervical ganglion
3rd order neuron from superior cervical ganglion to various sympathetic innervations.
***look at all landmarks
horner syndrome associations
1) pan coast tumor
2) Brown-Sequard
3) late-stage syringomyelia.
Superior oblique functions
Abducts, introits, and depresses while adducted
ocular motility diagram
FA 488
How do you test for SO function?
Have patient look down.
How do you test for IO function?
Have patient look up.
Pathophys of CN III motor dysfunction
Due primarily to vascular disease (DM: glucose –> sorbitol) due to decreased diffusion of oxygen and nutrients to the interior fibers from compromised vasculature residing on outside of nerve.
Pathophys of CN III PS dysfunction
Fibers on periphery are first affected by compression.
Causes of CN III PS dysfunction
1) posterior communicating artery aneurysm
2) uncle herniation
CN IV palsy presentation
1) eyes move upward, particularly with contralateral gaze
2) head tilt toward side of lesions (problems going down stairs, may present with compensatory head tilt in opposite direction).
CN VI palsy presentation
Medially directed eye that can’t abduct