Neuro-ophthalmology

Question 1

Distinguishing features in diplopia

Answer 1

Monocular or binocular, horizontal or vertical, other concurrent symptoms, onset, ocular motility

Question 2

How many cardinal positions of gaze are there

Answer 2

9

Question 3

Tests for ocular motility

Answer 3

Exmaination of eye movement range, cover and uncover test, alternate cover test, test for stereopsis

Question 4

Causes of III nerve palsy

Answer 4

Idiopathic, vascular or aneurysm

Question 5

Causes of vascular III nerve palsy

Answer 5

HTN, diabetes

Question 6

Aneurysm causes of III nerve palsy

Answer 6

Posterior communicating artery

Question 7

Position of eye in IV nerve palsy

Answer 7

Vertical deviation

Question 8

What is the role of the muscle in the affected eye of IV nerve palsy

Answer 8

Depression and inortion (reading muscle)

Question 9

What does the mneumonic WOOG mean

Answer 9

Worst on opposite gaze

Question 10

Which palsy is WOOG true for?

Answer 10

Trochlear nerve palsy

Question 11

What does the mneumonic BOOT mean

Answer 11

Best on opposite tilt (head)

Question 12

Which palsy is BOOT true for

Answer 12

Trochlear nerve palsy

Question 13

What are the causes of trochlear nerve palsy

Answer 13

Congenital, trauma (closed head injuries), and microvascular (less common)

Question 14

Which palsy is the most common

Answer 14

Abducens

Question 15

What can the eye not do in VI nerve palsy

Answer 15

Look up and to the effected side

Question 16

Childhood causes of VI nerve palsy

Answer 16

Congenital, trauma, tumour, elevated ICP, meningitis

Question 17

Adult causes of VI nerve palsy

Answer 17

Microvascular, tumour, GCA, idiopathic, stroke, vasculitis

Question 18

What is papilloedema

Answer 18

BILATERAL disc swelling secondary to INCREASED ICP

Question 19

Radiological findings of papilloedema

Answer 19

Empty sella, dilation of optic nerve sheath, posterior scleral flatterning, bilateral transverse sinus stenosis

Question 20

Causes of papilloedema

Answer 20

Any cause of increased ICP - tumour, haemorrhage, trauma. Meningitis, cerebral venous thrombosis, and secondary to systemic causes

Question 21

What is common childhood cause of papilloedema

Answer 21

Craniosynostoses

Question 22

What is the LP opening pressure to confirm raised ICP

Answer 22

> 35cm

Question 23

Symptoms of papilloedema

Answer 23

Headaches, nausea, tinnitus, diplopia, no symptoms, visual acuity and colour vision worse or same, pupils normal

Question 24

What is the grading system used for papilloedema

Answer 24

Frisen on scale of 1-5

Question 25

What is amaurosis fagux

Answer 25

Transient monocular vision loss or diming. May last minutes or hours. Normal eye examination, normal neurology exam, no GCA symptoms.

Question 26

Causes of Amaurosis fagux

Answer 26

Carotid atheroma, cardiac valve disease, atrial myxoma, retinal migraine, GCA, hyperviscosity syndromes

Question 27

What is myasthenia gravis

Answer 27

Autoimmune disorder characterised by presence of antibodies which block the ACh receptor sites on any muscle

Question 28

What % of myasthenia gravis patients have eye problems

Answer 28

50%

Question 29

Signs of myasthenia gravis

Answer 29

Ptosis, ocular motility distrubances, INO, variability, eyes getting tired as day goes on

Question 30

Treatment of myasthenia gravis

Answer 30

ACh inhibitors, steroids, immunosupressants, plasmapheresis, thymectomy

Question 31

Investigations when suspected myasthenia gravis

Answer 31

Clinical, tensilon test, serological, sleep test, ice pack test, CT chest, TFTs and ANA