Neuro Ophthalmology 2 Flashcards
All of the EOM’s controlling motility of globe receive their innervation 1/3 distance from the apex except which one?
Inferior oblique is 1/2 distance from origin to insertion
All EOM’s receive their innervation on the undersurface except which one?
SO
What is the only cranial nerve within the substance of the cavernous sinus?
VI
What is a normal photostress test? Do people with optic neuropathy have normal or abnormal photostress tests?
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)
What is the most common cancer associated with CAR?
small cell lung carcinoma
What is usually the 1st line treatment for IIH?
acetozolamide; another good option is topiramate as it helps with HA, appetite suppression, and is also CAI
What is a FA finding suggestive of GCA when exam shows normal DFE?
FA shows delayed or absent choroidal filling corresponding to posterior ciliary artery blockage
How long can you delay TA biopsy after starting steroids?
7-10 days
Do you get optic nerve enhancement in NAION?
no unlike in optic neuritis
Do you have to have DR if you have diabetic pappilopathy?
No, but a patient usually would have DR
Is leber hereditary optic neuropathy acute or slowly progressive in onset?
acute
What is the classic triad seen on exam for leber hereditary optic neuropathy?
- 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
How soon does the originally unaffected eye become affected in LHON?
weeks to months
What is the most common hereditary optic neuropathy?
Autosomal dominant optic atrophy
What type of color deficit do kids with autosomal dominant optic atrophy have?
tritanopia (requiring HRR screening)
What type of visual defects to people with autosomal dominant optic atrophy usually have?
cecocentral
What is generally the course of people with autosomal dominant optic atrophy?
Slowly progressive, VA usually not worse than 20/200
A child with optic nerve hypoplasia should have what done?
MRI scan and endocrine consult (De Morsier’s syndrome)
Superior segmental optic nerve hypoplasia is usually seen in mothers with what?
DM
Bilateral inferonasal tilted discs (colobomatous excavation) is what condition?
Congenital tilted disc syndrome
What is the morning glory disc anomoly?
It is a posterior staphyloma involving the optic nerve and peripapillary area. usually unilateral
What should be done in the work-up when a morning glory optic disc is discovered?
Neuroimaging to evaluate for a basal encephalocele and CNS vascular anomalies
Pituitary adenomas usually cause what type of visual field defect specifically? Craniopharyngiomas?
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
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?
Posterior parietal lobe
What are 3 common causes of transient monocular visual loss caused by hypoperfusion?
- CRVO or impending CRVO2. Change in postural position3. Ocular ischemic syndrome
What are 4 common causes of binocular transient visual loss?
- Migraine2. Occipital mass lesion3. Occipital ischemia (this includes vertebrobasilar insufficiency)4. Occipital seizures
Which muscle does the right CN IV nucleus innervate?
The left superior oblique. CN IV fibers decussate
The amsler grid test the central ____ degrees of visual field.
20
Benign episodic pupillary mydriasis is associated with what other neurological condition?
Migraines, does not have to coincide with the migraine HA
phosphenes
fleeting, bright flashes of light that last up to 45 minutes and may be followed by a HA. Due to retinal vasospasms
Palinopsia
visual perseveration after the removal of the original stiumulus (multiple after images) localizing to the non-dominant parieto-occipital area
Alexia without agraphia is usually caused by infarction of what?
left occipital lobe and fibers crossing in the splenium of the corpus collosum
What is the exception to the rule that supranuclear lesions do not cause diplopia (infranuclear lesions do)?
Skew deviation + vergence disorders (e.g. convergence/divergence insufficiency, convergence spasm)
The vestibular ocular response is only a short lived response, what supplements this response for longer duration?
The optokinetic system
What are microsaccadic refixation movements?
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.
What ocuar movement systems does the OKN test?
Smooth pursuit and saccadic systems. It does not test OKN system which cannont be isolated in the clinical setting
What is the ocular tilt reaction?
Skew deviation, head tilt, and cyclotorsional rotation of eyes
What is usually the involved artery (s) in Wallenberg syndrome?
PICA or vertebral
In ocular tilt reaction the upper poles of both eyes rotates towards the higher or lower ear?
Lower; the opposite is true for a normal person without pathology
INO causes slowed adducting saccadic velocity in 1 eye and contraleral abducting nystagmus. Which side is the INO?
The side with slowed adducting saccadic velocity
What causes a skew deviation (which is a vertical acquired misalignment)?
disruption of supranuclear input from the otolithic organs
