Neuro Ophthalmology 3

Question 1

What is a WEBINO syndrome?

Answer 1

stands for Wide Eyed Bilatearl INO which is a result of a bilateral INO causing large angle exodeviation usually the result of a lesion at the midbrain near CN III nuclei

Question 2

What are the two most common causes of INO?

Answer 2

Demyelination (younger) and stroke (older)

Question 3

What is One and a Half syndrome?

Answer 3

Horizontal gaze palsy combined with ipsilateral INO

Question 4

Which horizontal movement remains in one and a half syndrome?

Answer 4

contralateral abduction (1 and 1/2 b/c other horzontal movements are not functional)

Question 5

Which aneurysm is most commonly involved causing a 3rd nerve pupil inovling palsy?

Answer 5

PCOM

Question 6

Which is more concerning, pupil sparing in setting of complete CN3 or incomplete (partial) CN3 palsy

Answer 6

partial pupil sparing CN3 palsy because this could be due to compression instead of microvascular as in the complete pupil sparing CN3 palsy

Question 7

What is neuromytonia? What is its treatment?

Answer 7

radiation induced eom spasms that last 30-60 seconds that cause intermittant diplopia. Treatment is with carbamazepine

Question 8

What is the deficit in Brown syndrome (congenital or acquired)?

Answer 8

Limited upgaze when the affected eye is in the adducted position

Question 9

What is the cause of Brown syndrome?

Answer 9

Congenital: short SO tendon (does not allow eye to go up because it is too short)Acquired: scarring, fibrosis, neoplasm, etc of the trochlear which does not allow the tendon to freely pass

Question 10

Does nystagmus have to have a slow phase according to definition? Fast phase?

Answer 10

Yes; noNystagmus is a rhythmic to and from movement that has a slow phase and does not have to have a fast phase

Question 11

What is jerk nystagmus?

Answer 11

Has slow phase with a corrective saccade (fast phase)

Question 12

What is pendular nystagmus?

Answer 12

Has only back and forth slow phases

Question 13

Are saccadic oscillations and saccadic intrusions true nystagmus?

Answer 13

No because they are only saccadic movements (fast phase) but they are pathologic

Question 14

What is dissociative nystagmus?

Answer 14

Nystagmus that has different amplitudes in each eye

Question 15

What is disconjugate nystagmus?

Answer 15

Nystagmus that has different directions in each eye.

Question 16

What type of nystagmus does infantile nystagmus syndrome show?

Answer 16

pendular or jerk that is horzontal and conjugate

Question 17

Which was does latent nystagmus beat?

Answer 17

Fast phase temporally of the viewing eye (this means the occluded is beating towards the nose). Switches when the other eye is occluded

Question 18

What type of deviation is highly associated with latent nystagmus?

Answer 18

Esotropia as well as DVD

Question 19

What should be done with Monocular nystagmus of childhood?

Answer 19

A work-up including neuroimaging as there could be a tumor. latent nystagmus and infantile nystagmus syndromes are both bilateral and benign.

Question 20

What is one obvious characteristic that distinguishes spasmus mutans from infantile nystagmus syndrome?

Answer 20

abnormal head nodding

Question 21

Because spasmus mutans can be monocular and present with variable patterns of nystagmus looking much like monocular nystagmus of childhood, what should be done in work-up?

Answer 21

neuro-imaging, looking for glioma

Question 22

Fast phase in the direction of eccentric gaze with increasing amplitude as the eyes move further to that direction describes what type of nystagmus?

Answer 22

gaze-evoked nystagmus which is benign unless there is assymetry

Question 23

prolonged eccentric viewing and then return to primary gaze with fast beat in opposite direction is characteristic of what type of nystagmus?

Answer 23

rebound nystagmus; often a manifestation of cerebellar disease

Question 24

Nystagmus that occurs after vestibular injury/disease (e.g. Meniere’s, aminoglycoside toxicity) is termed what?

Answer 24

Vestibular nystagmus

Question 25

Alexander’s law of nystagmus states that…

Answer 25

nystagmus is more pronounced when looking towards the direction of fast beat

Question 26

nystagmus due to a lesion (e.g. Arnold Chiari type 1 malformation) at the cervico-medullary junction causes what type of nystagmus?

Answer 26

Down beat

Question 27

Upbeat nystagmus localizes to the…

Answer 27

posterior fossa

Question 28

periodic alternating nystagmus localizes to the….

Answer 28

cerebellar nodulus

Question 29

ocular bobbing localizes to the…

Answer 29

pons (pontine destructive lesion)

Question 30

ocular flutter/opsoclonus localizes to the…

Answer 30

pons or cerebellum

Question 31

See-saw nystagmus localizes to the…

Answer 31

parasellar/diencephalon region

Question 32

Nystagmus associated with palatal synchronous movements is termed what?

Answer 32

oculopalatal myoclonus

Question 33

Disconjugate nystagmus in which 1 eye elevates and intorts while the other eye depresses and extorts is termed what?

Answer 33

See-Saw nystagmus

Question 34

What percentage of the population has physiologic anisicoria?

Answer 34

20%

Question 35

What percentage of MS patients will have optic neuritis as their presenting symptom?

Answer 35

25%

Question 36

Adenoma Sabaceum, cognitive deficiency, and epilepsy describe what condition?

Answer 36

Tuberous sclerosis; ashleaf spot is pathognomonic

Question 37

Retinal capillary angioma with a single feeding and draining vessel is characteristic of what syndrome?

Answer 37

Von Hippel disease which will have a capilliary angioma; not Sturge Weber which has choriodal hemangioma

Question 38

Racemose angioma has ipsilateral AVM which warrant MRI neuroimaging. What phocomatoses is this?

Answer 38

Wyburn Mason syndrome

Question 39

Which of the phacomatoses has AR inheritance?

Answer 39

Ataxia-telangectasia; the rest are sporadic or AD