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Neurosurgery Resource > Neuro-Ophthalmology > Flashcards

Neuro-Ophthalmology Flashcards

1
Q

The optic nerve is formed by the convergence of which cells?

A

Retinal ganglion cells

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2
Q

The optic tract connects which two structures?

A

Optic chiasm and lateral geniculate nuclei

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3
Q

The optic tract conveys signals from the contralateral nasal retina and ipsilateral temporal retina. True/false?

A

True

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4
Q

The optic radiations connect which structures?

A

Lateral geniculate nuclei and visual cortex

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5
Q

Superior optic radiations pass through the temporal lobe and inferior optic radiations pass through through the parietal lobe. True/false?

A

False - superior optic radiations pass through parietal lobe and inferior optic radiations pass through temporal lobe

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6
Q

The oculomotor nerve is accompanied by parasympathetic fibres that innervate what?

A

Sphincter papillae

Ciliary muscles

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7
Q

Where are the trochlear nuclei located?

A

Midbrain

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8
Q

Where is the abducens nucleus located?

A

Pontine tegmentum

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9
Q

What nerves supply the afferent and efferent limbs of the pupillary light reflex?

A

Afferent limb - CN II

Efferent limb - CN III

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10
Q

Light projected along the eye is projected to which nuclei?

A

Edinger-Westphal

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11
Q

Where do parasympathetic fibres from the Edinger-Westphal nuclei synapse?

A

Ciliary ganglion

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12
Q

Parasympathetic fibres are carried from short ciliary nerves to innervate which structures?

A

Ciliary muscle

Sphincter pupillae

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13
Q

What causes lens curvature to increase in the accommodation reflex?

A

Ciliary muscle contracts causing relaxation of suspensory lens ligaments

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14
Q

What are the main signs of CN II dysfunction?

A 
Decreased VA
Dyschromatopsia
Visual field defects
Diminished contact sensitivity
RAPD
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15
Q

What is optic neuritis?

A

Inflammation of the optic nerve

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16
Q

Give some ophthalmic clinical features of MS

A

Optic neuritis
Internuclear ophthalmoplegia
Nystagmus

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17
Q

How is optic neuritis treated?

A

IV methylprednisolone

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18
Q

What is neuromyelitis optica?

A

Demyelinating disorder with bilateral optic neuritis and transverse myelitis

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19
Q

What occurs in anterior ischaemic optic neuropathy?

A

Damage to CN II due to ischaemia

20
Q

What is papilloedema?

A

Optic disc swelling secondary to elevated ICP

21
Q

Give some clinical features of papilloedema

A 
Headache
N + V
Transient visual loss
Enlarged blind spot
Blurred optic disc margins
Splinter haemorrhages
22
Q

What are the clinical features of Horner’s syndrome?

A

Ptosis (drooping eyelid)
Miosis (constriction)
Ipsilateral anhidrosis

23
Q

What can be used to confirm Horner’s pupil?

A

Apraclonidine

24
Q

What occurs in lateral medullary syndrome?

A

Ischaemia to lateral part of medulla

25
Q

What can be affected in lateral medullary syndrome?

A

Vestibular nucleus
Descending sympathetic system
Spinal trigeminal tract
Spinothalamic tract

26
Q

What is the cause of Adie’s pupil?

A

Loss of postganglionic parasymapthetic innervation to iris sphincter and ciliary muscle

27
Q

Give some clinical features of Adie’s pupil

A

Anisocoria
absent light reflex
Absent deep tendon reflex of lower limbs

28
Q

How can Adie’s pupil be investigated?

A 
Slit lamp
Topical pilocarpine (Adie's pupil constricts)
29
Q

Describe an Argyll-Robertson pupil

A

Bilateral, irregular and small

30
Q

A chiasmatic optic nerve lesion causes which visual defect?

A

Bitemporal hemianopia

31
Q

An optic tract lesion causes which visual defect?

A

Contralateral homonymous hemianopia

32
Q

A temporal radiation lesion causes which visual defect?

A

Contralateral superior homonymous quadrantanopia

33
Q

A parietal radiation lesion causes which visual defect?

A

Contralateral inferior homonymous quadrantopia

34
Q

A lesion of the main optic radiations causes which visual defect?

A

Contralateral homonymous hemianopia

35
Q

An occipital cortex lesion causes which visual field defect?

A

Contralateral homonymous hemianopia with macular sparing

36
Q

Give some clinical features of a third nerve palsy

A

Ptosis
Abduction and depression of eye
Dilated pupil

37
Q

Give some clinical features of a fourth nerve palsy

A

Vertical diplopia
Hypertropia
Limited eye depression
Compensatory head tilt

38
Q

Give some clinical features of a sixth nerve palsy

A

Horizontal double vision
Esotropia
Limited abduction

39
Q

Give some ocular features of myasthenia gravis

A

Ptosis (typically bilateral)
Diplopia
Ophthalmoplegia

40
Q

Give some ocular features of myotonic dystrophy

A

Early onset cataract
Ptosis
Hypermetropia
Ophthalmoplegia

41
Q

Give some ophthalmic features of neurofibromatosis type I

A

Optic nerve glioma
Bilateral Lisch nodules
“Bag of worm” sensation

42
Q

What is benign essential belpharospasm?

A

An idiopathic condition with involuntary contraction of orbicularis oculi muscle

43
Q

What is the treatment for benign essential blepharospasm?

A

Artificial tears

Botulinum injection

44
Q

Give some clinical features of cavernous sinus syndrome

A 
Ptosis and ophthalmoplegia
Loss of corneal reflex
Maxillary sensory loss
Horner's syndrome
Proptosis and periorbital swelling
45
Q

Give some causes of cavernous sinus syndrome

A

Infection
Tumours
Internal carotid aneurysms

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