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Neuro Ophthalmology > Neuro Ophthalmology 2 > Flashcards

Neuro Ophthalmology 2 Flashcards

1
Q

All of the EOM’s controlling motility of globe receive their innervation 1/3 distance from the apex except which one?

A

Inferior oblique is 1/2 distance from origin to insertion

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2
Q

All EOM’s receive their innervation on the undersurface except which one?

A

SO

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3
Q

What is the only cranial nerve within the substance of the cavernous sinus?

A

VI

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4
Q

What is a normal photostress test? Do people with optic neuropathy have normal or abnormal photostress tests?

A

Ability to read 1 line worse than BCVA after bright light shined in eye X 10 secs within 30 seconds of removal of light. Optic Neuropathy should have normal stress tests whereas maculopathy or OIS should have abnormal (>90secs)

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5
Q

What is the most common cancer associated with CAR?

A

small cell lung carcinoma

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6
Q

What is usually the 1st line treatment for IIH?

A

acetozolamide; another good option is topiramate as it helps with HA, appetite suppression, and is also CAI

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7
Q

What is a FA finding suggestive of GCA when exam shows normal DFE?

A

FA shows delayed or absent choroidal filling corresponding to posterior ciliary artery blockage

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8
Q

How long can you delay TA biopsy after starting steroids?

A

7-10 days

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9
Q

Do you get optic nerve enhancement in NAION?

A

no unlike in optic neuritis

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10
Q

Do you have to have DR if you have diabetic pappilopathy?

A

No, but a patient usually would have DR

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11
Q

Is leber hereditary optic neuropathy acute or slowly progressive in onset?

A

acute

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12
Q

What is the classic triad seen on exam for leber hereditary optic neuropathy?

A
  1. Hyperemic disc edema without leakage on FA2. Peripapillary telangiectasia3. tortuosity of medium sized-retinal arteriolesMany patients won’t have any fundus exam findings on presentations
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13
Q

How soon does the originally unaffected eye become affected in LHON?

A

weeks to months

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14
Q

What is the most common hereditary optic neuropathy?

A

Autosomal dominant optic atrophy

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15
Q

What type of color deficit do kids with autosomal dominant optic atrophy have?

A

tritanopia (requiring HRR screening)

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16
Q

What type of visual defects to people with autosomal dominant optic atrophy usually have?

A

cecocentral

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17
Q

What is generally the course of people with autosomal dominant optic atrophy?

A

Slowly progressive, VA usually not worse than 20/200

18
Q

A child with optic nerve hypoplasia should have what done?

A

MRI scan and endocrine consult (De Morsier’s syndrome)

19
Q

Superior segmental optic nerve hypoplasia is usually seen in mothers with what?

A

DM

20
Q

Bilateral inferonasal tilted discs (colobomatous excavation) is what condition?

A

Congenital tilted disc syndrome

21
Q

What is the morning glory disc anomoly?

A

It is a posterior staphyloma involving the optic nerve and peripapillary area. usually unilateral

22
Q

What should be done in the work-up when a morning glory optic disc is discovered?

A

Neuroimaging to evaluate for a basal encephalocele and CNS vascular anomalies

23
Q

Pituitary adenomas usually cause what type of visual field defect specifically? Craniopharyngiomas?

A

Pituitary adenomas come from below and cause bilateral temporal hemianopias usually in the superior VFCraniopharyngiomas occur from above and cause bilateral temporal hemianopias usually in the inferior VF more

24
Q

A patient with a homonymous hemianopia defect elicting a reduced OKN testing response towards the affected side has a lesion in what part of the brain?

A

Posterior parietal lobe

25
Q

What are 3 common causes of transient monocular visual loss caused by hypoperfusion?

A
  1. CRVO or impending CRVO2. Change in postural position3. Ocular ischemic syndrome
26
Q

What are 4 common causes of binocular transient visual loss?

A
  1. Migraine2. Occipital mass lesion3. Occipital ischemia (this includes vertebrobasilar insufficiency)4. Occipital seizures
27
Q

Which muscle does the right CN IV nucleus innervate?

A

The left superior oblique. CN IV fibers decussate

28
Q

The amsler grid test the central ____ degrees of visual field.

A

20

29
Q

Benign episodic pupillary mydriasis is associated with what other neurological condition?

A

Migraines, does not have to coincide with the migraine HA

30
Q

phosphenes

A

fleeting, bright flashes of light that last up to 45 minutes and may be followed by a HA. Due to retinal vasospasms

31
Q

Palinopsia

A

visual perseveration after the removal of the original stiumulus (multiple after images) localizing to the non-dominant parieto-occipital area

32
Q

Alexia without agraphia is usually caused by infarction of what?

A

left occipital lobe and fibers crossing in the splenium of the corpus collosum

33
Q

What is the exception to the rule that supranuclear lesions do not cause diplopia (infranuclear lesions do)?

A

Skew deviation + vergence disorders (e.g. convergence/divergence insufficiency, convergence spasm)

34
Q

The vestibular ocular response is only a short lived response, what supplements this response for longer duration?

A

The optokinetic system

35
Q

What are microsaccadic refixation movements?

A

Small movements (0.1-0.2 degrees) that are involuntarily controlled to allow for constant change in foveal fixation so that image does not attenuate. Square wave.

36
Q

What ocuar movement systems does the OKN test?

A

Smooth pursuit and saccadic systems. It does not test OKN system which cannont be isolated in the clinical setting

37
Q

What is the ocular tilt reaction?

A

Skew deviation, head tilt, and cyclotorsional rotation of eyes

38
Q

What is usually the involved artery (s) in Wallenberg syndrome?

A

PICA or vertebral

39
Q

In ocular tilt reaction the upper poles of both eyes rotates towards the higher or lower ear?

A

Lower; the opposite is true for a normal person without pathology

40
Q

INO causes slowed adducting saccadic velocity in 1 eye and contraleral abducting nystagmus. Which side is the INO?

A

The side with slowed adducting saccadic velocity

41
Q

What causes a skew deviation (which is a vertical acquired misalignment)?

A

disruption of supranuclear input from the otolithic organs

Neuro Ophthalmology (4 decks)

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