Neuro Ophthalmology 2

Question 1

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

Answer 1

Inferior oblique is 1/2 distance from origin to insertion

Question 2

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

Answer 2

SO

Question 3

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

Answer 3

VI

Question 4

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

Answer 4

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)

Question 5

What is the most common cancer associated with CAR?

Answer 5

small cell lung carcinoma

Question 6

What is usually the 1st line treatment for IIH?

Answer 6

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

Question 7

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

Answer 7

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

Question 8

How long can you delay TA biopsy after starting steroids?

Answer 8

7-10 days

Question 9

Do you get optic nerve enhancement in NAION?

Answer 9

no unlike in optic neuritis

Question 10

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

Answer 10

No, but a patient usually would have DR

Question 11

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

Answer 11

acute

Question 12

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

Answer 12

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

Question 13

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

Answer 13

weeks to months

Question 14

What is the most common hereditary optic neuropathy?

Answer 14

Autosomal dominant optic atrophy

Question 15

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

Answer 15

tritanopia (requiring HRR screening)

Question 16

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

Answer 16

cecocentral

Question 17

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

Answer 17

Slowly progressive, VA usually not worse than 20/200

Question 18

A child with optic nerve hypoplasia should have what done?

Answer 18

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

Question 19

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

Answer 19

DM

Question 20

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

Answer 20

Congenital tilted disc syndrome

Question 21

What is the morning glory disc anomoly?

Answer 21

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

Question 22

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

Answer 22

Neuroimaging to evaluate for a basal encephalocele and CNS vascular anomalies

Question 23

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

Answer 23

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

Question 24

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?

Answer 24

Posterior parietal lobe

Question 25

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

Answer 25

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

Question 26

What are 4 common causes of binocular transient visual loss?

Answer 26

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

Question 27

Which muscle does the right CN IV nucleus innervate?

Answer 27

The left superior oblique. CN IV fibers decussate

Question 28

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

Answer 28

20

Question 29

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

Answer 29

Migraines, does not have to coincide with the migraine HA

Question 30

phosphenes

Answer 30

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

Question 31

Palinopsia

Answer 31

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

Question 32

Alexia without agraphia is usually caused by infarction of what?

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

The optokinetic system

Question 35

What are microsaccadic refixation movements?

Answer 35

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.

Question 36

What ocuar movement systems does the OKN test?

Answer 36

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

Question 37

What is the ocular tilt reaction?

Answer 37

Skew deviation, head tilt, and cyclotorsional rotation of eyes

Question 38

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

Answer 38

PICA or vertebral

Question 39

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

Answer 39

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

Question 40

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

Answer 40

The side with slowed adducting saccadic velocity

Question 41

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

Answer 41

disruption of supranuclear input from the otolithic organs