Neuro Ophthalmology 3 Flashcards
What is a WEBINO syndrome?
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
What are the two most common causes of INO?
Demyelination (younger) and stroke (older)
What is One and a Half syndrome?
Horizontal gaze palsy combined with ipsilateral INO
Which horizontal movement remains in one and a half syndrome?
contralateral abduction (1 and 1/2 b/c other horzontal movements are not functional)
Which aneurysm is most commonly involved causing a 3rd nerve pupil inovling palsy?
PCOM
Which is more concerning, pupil sparing in setting of complete CN3 or incomplete (partial) CN3 palsy
partial pupil sparing CN3 palsy because this could be due to compression instead of microvascular as in the complete pupil sparing CN3 palsy
What is neuromytonia? What is its treatment?
radiation induced eom spasms that last 30-60 seconds that cause intermittant diplopia. Treatment is with carbamazepine
What is the deficit in Brown syndrome (congenital or acquired)?
Limited upgaze when the affected eye is in the adducted position
What is the cause of Brown syndrome?
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
Does nystagmus have to have a slow phase according to definition? Fast phase?
Yes; noNystagmus is a rhythmic to and from movement that has a slow phase and does not have to have a fast phase
What is jerk nystagmus?
Has slow phase with a corrective saccade (fast phase)
What is pendular nystagmus?
Has only back and forth slow phases
Are saccadic oscillations and saccadic intrusions true nystagmus?
No because they are only saccadic movements (fast phase) but they are pathologic
What is dissociative nystagmus?
Nystagmus that has different amplitudes in each eye
What is disconjugate nystagmus?
Nystagmus that has different directions in each eye.
What type of nystagmus does infantile nystagmus syndrome show?
pendular or jerk that is horzontal and conjugate
Which was does latent nystagmus beat?
Fast phase temporally of the viewing eye (this means the occluded is beating towards the nose). Switches when the other eye is occluded
What type of deviation is highly associated with latent nystagmus?
Esotropia as well as DVD
What should be done with Monocular nystagmus of childhood?
A work-up including neuroimaging as there could be a tumor. latent nystagmus and infantile nystagmus syndromes are both bilateral and benign.
What is one obvious characteristic that distinguishes spasmus mutans from infantile nystagmus syndrome?
abnormal head nodding
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?
neuro-imaging, looking for glioma
Fast phase in the direction of eccentric gaze with increasing amplitude as the eyes move further to that direction describes what type of nystagmus?
gaze-evoked nystagmus which is benign unless there is assymetry
prolonged eccentric viewing and then return to primary gaze with fast beat in opposite direction is characteristic of what type of nystagmus?
rebound nystagmus; often a manifestation of cerebellar disease
Nystagmus that occurs after vestibular injury/disease (e.g. Meniere’s, aminoglycoside toxicity) is termed what?
Vestibular nystagmus
Alexander’s law of nystagmus states that…
nystagmus is more pronounced when looking towards the direction of fast beat
nystagmus due to a lesion (e.g. Arnold Chiari type 1 malformation) at the cervico-medullary junction causes what type of nystagmus?
Down beat
Upbeat nystagmus localizes to the…
posterior fossa
periodic alternating nystagmus localizes to the….
cerebellar nodulus
ocular bobbing localizes to the…
pons (pontine destructive lesion)
ocular flutter/opsoclonus localizes to the…
pons or cerebellum
See-saw nystagmus localizes to the…
parasellar/diencephalon region
Nystagmus associated with palatal synchronous movements is termed what?
oculopalatal myoclonus
Disconjugate nystagmus in which 1 eye elevates and intorts while the other eye depresses and extorts is termed what?
See-Saw nystagmus
What percentage of the population has physiologic anisicoria?
20%
What percentage of MS patients will have optic neuritis as their presenting symptom?
25%
Adenoma Sabaceum, cognitive deficiency, and epilepsy describe what condition?
Tuberous sclerosis; ashleaf spot is pathognomonic
Retinal capillary angioma with a single feeding and draining vessel is characteristic of what syndrome?
Von Hippel disease which will have a capilliary angioma; not Sturge Weber which has choriodal hemangioma
Racemose angioma has ipsilateral AVM which warrant MRI neuroimaging. What phocomatoses is this?
Wyburn Mason syndrome
Which of the phacomatoses has AR inheritance?
Ataxia-telangectasia; the rest are sporadic or AD
