Neuro-ophthalmology

Question 1

horner syndrome triad

route to eye

Answer 1

1) dilation lag
2) ptosis
3) anhidrosis

1) start in hypothal –> brainstem –> cervical cord to C8-T1 –> superior cevical ganglion –> carotid, trigeminal, cavernous sinus

Question 2

aniscoria cause/not vision loss?

Answer 2

does not cause

Question 3

pupillary anisocoria result of?

Answer 3

efferent nervous system disturbance to iris muscles or local iris injury/damage

Question 4

vessels emerge from optic disk and move…

Answer 4

superior/inferior and temporally

Question 5

examination steps for pupillary disturbances

Answer 5

1) look for anisocoria (diff in size btwn pupils)
2) check normal reaction of pupil in light and dark
3) observe pupillary response to light
4) check for segmental palsy (unequal constriction of pupil)
5) check for light-near dissociation (better constriction when viewing near object than light stim)

check for tonic dilation at distant target

Question 6

if anisocoria is greater in dark and both pupil have normal light response, then which is abnormal pupill

due to?

Answer 6

smaller pupil = abnormal

due to sympath dysfunction from Horner syndrome

Question 7

if anisocoria is greater in light and large pupil has poor response to light then which is abnormal puil

Answer 7

larger pupil = abnormal

parasympathetic problems

Question 8

sympathetic disturbances

sympathetic innerv normally causes (dilation/constrict pupil)

if damaged sympathetic, abnormal pupil appears ____ and anisocoria worse when?

Answer 8

normally = dilation

if damaged, abnormal pupil = miotic and abnormal dark reaction so won’t fully dilate –> makes anisocoria worse in dark

Question 9

parasymapthd isturbances

parasympath innerv normally causes (dilation/constrict pupil)

if damaged parasympathetic, abnormal pupil appears ____ and anisocoria worse when?

Answer 9

normally = pupillary constriction

if damaged pupil mydriatic and poorly responsive to light
anisocoria worse in LIGHT

Question 10

horner syndrome
1) symp or parasymp problem

2) anisocoria
3) light reaction
4) other signs

Answer 10

1) symp problem
2) miosis
3) abnormal dark reaction
4) accompanied by ptosis and anhidrosis usu unilat

Question 11

iris damage

1) symp or parasymp problem
2) anisocoria
3) light reaction
4) other signs

Answer 11

1) parasymp problem
2) mydriasis
3) abnormal light reaction
4) non-neuro

Question 12

3rd nerve palsy

1) symp or parasymp problem
2) anisocoria
3) light reaction
4) other signs

Answer 12

1) parasymp problem
2) mydriasis
3) abnormal light reaction
4) ptosis and EOM paresis

Question 13

tonic pupil

1) symp or parasymp problem
2) anisocoria
3) light reaction
4) other signs

Answer 13

1) parasymp problem
2) mydriasis
3) abnormal light reaction
4) light-near dissoc from regrowth of nerve fibers and segmental constriction

Question 14

hallmarks of visual field defects

Answer 14

1) defect respects vertical and horizontal meridian (optic nerve and beyond)
2) homonymous field loss (optic tract and beyond)
3) defect = combo of homonymous field loss + respect of vertical meridian (optic tract and beyond)

Question 15

exception to visual field defect

Answer 15

optic nerve

Question 16

optic nerve disturbance
1) complaints

2)
assoc symptoms
assoc signs
appearance of nerve

3) exam for

Answer 16

1) monocular vision loss (blurred, missing, dim)
decr brightness or color vision impaired

2) assoc symptoms = HA
assoc signs = proptosis, retinal disease
appearance of nerve = swollen or normal

Question 17

optic nerve disturbance
APD= marcus gunn syndrome
1) where is dysfunction

2) test using…
3) other exam findings

Answer 17

1) dysfunction prior to synapse of retinal ganglion in thalamus (btwn LGN and pupil)

2) test using swinging light test
if light shined at one side and both pupi constrict then light is shined in other eye and it dilate –> APD

LGN sees relatively less light than other side and dilates

3) color vision loss
visual acuity loss
pale or hemorrhage optic nerve

Question 18

ANISOCORIA NEVER OCCURS BECAUSE OF ___

Answer 18

vision loss

Question 19

if optic chiasm compressed what does visual field look like

Answer 19

bitemporal hemianopsia

Question 20

if left optic radiation (meyer’s loop affected)

Answer 20

affects upper right quadrant in both eyes

vision loss in field opposite of retinal pathways

Question 21

if left inferior occipital lobe affected

Answer 21

right upper quadrant sparing macula

has macular sparing so posterior calcarine sulcus problem

oppsoite visual field =

Question 22

4 questions to address in diplopia evaluation

Answer 22

1) is diplopia binocular
2) is diplopia horiz or vertical
3) is diplopia worse in specific positiosn of gaze
4) is diplopia worse at near or distance viewing

Question 23

if diplopia binocular this could be ___

Answer 23

eyes misaligned due to NEJM of causes

1) nerve (CN 3, 4, 6 palsy)
2) eye displaced
3) NMJ (myasthenia gravis)
4) muscle (thyroid)

Question 24

oscillopia is ___

most common type?

Answer 24

appearance of movement in someone’s visual world due to eye movement disturbance

nystagmus = involuntary rhythmic oscillation

Question 25

3 types of nystagmus

Answer 25

1) pendular (slow-slow)
2) jerk (fat-slow)
3) mixed (slow-slow and fast-slow)

Question 26

nystagmus is localized to ___

downbeat nystagmus is localized to ___ with what diseases

affects what brain area why?

Answer 26

CN 8 or CNS

downbeat nystagmus = cervical medullary junction causing eye to go up and down due to MS, chiari malform, tumor

affects flocculus which normally inhib anterior semicircular canals connection (which stim eyes to move up) so eyes drift up and then down