Neuro-ophthalmology

Question 1

Definition of Nystagmus

Answer 1

Repetitive, involuntary to-and-fro eye oscillation which may be pathological or physiological

Question 2

Primary congenital nystagmus, primary gaze

Answer 2

low amplitude pendular nystagmus that converts jerk nystagmus on side gaze

Question 3

Explain Latent Nystagmus

Answer 3

Associated with infantile esotropia or dissociated vertical deviation
both eyes open, no nystagmus
nystagmus apparent when covering one eye or when light entering eye is reduced.

Question 4

Describe classical migraine

Answer 4

migraine with aura that last for 20 minutes, headache is hemicranial and associated with symptoms of nausea, photophobia and phonophobia

Question 5

Describe common migraine

Answer 5

Pounding or throbbing headache, absent of symptoms, patient often photophobic and phonophobic

Question 6

Managements for migraines

Answer 6

Avoid food, beverages such as coffee/chocolate/cheese/alcohol, oral contraceptive pills, stress, lack of sleep, long intervals without food
Medicine for prophylaxis and acute attack

Question 7

Signs of optic nerve dysfunction

Answer 7

Poor VA, APD, poor light brightness sensitivity, poor contrast sensitivity, dyschromatopsia, visual field defect

Question 8

Primary optic atrophy pathogenesis

Answer 8

Occurs without swelling of ONH, may be due to lesions affecting the visual pathway from the retrolaminar portion of the optic nerve to the lateral geniculate body

Question 9

Primary optic atrophy signs

Answer 9

pale, flat disc with clearly delineated margins.

atrophy may be diffused or sectoral

Question 10

Primary optic atrophy causes

Answer 10

Demyelinating optic neuritis, toxic and nutritional optic neuropathy

Question 11

Demyelinating optic neuritis presentation

Answer 11

2nd to 5th decade of life subacute monocular visual impairment with discomfort around eye, worsen with eye movement

Question 12

Demyelinating optic neuritis signs

Answer 12

Disc is normal, temporal disc pallor indicates previous attacks, signs of optic nerve dysfunction

Question 13

Demyelinating optic neuritis course

Answer 13

worsen up to 2 weeks then begins to improve

Question 14

Demyelinating optic neuritis prognosis

Answer 14

VA better than 6/9 in 75%, associated with multiple sclerosis

Question 15

Demyelinating optic neuritis management

Answer 15

refer neuro-ophthalmologist for confirmation and treatment to speed recovery

Question 16

Nutritional optic neuropathy presentation

Answer 16

Insidious onset of progressive, bilateral, symmetrical visual impairment associated with dyschromatopsia

Question 17

Nutritional optic neuropathy signs

Answer 17

Normal optic disc, bilateral centrocaecal scotomas

Question 18

Nutritional optic neuropathy management

Answer 18

Refer to ophthalmologist for treatment

Question 19

Secondary optic atrophy pathogenesis

Answer 19

Preceded by swelling of the ONH

Question 20

Secondary optic atrophy signs

Answer 20

White/ dirty grey, slightly elevated disc, poorly delineated margin
Reduction in number of vessels

Question 21

Secondary optic atrophy causes

Answer 21

Chronic papilloedema, Anterior ischemic optic neuropathy

Question 22

Non-Arteritic Anetrior Ischaemic Optic Neuropathy pathogenesis

Answer 22

infarction of ONH caused by occlusion of short posterior ciliary arteries

Question 23

Non-Arteritic Anterior Ischaemic Optic Neuropathy presentation

Answer 23

6th to 7th decade, sudden, painless mono visual loss, no forewarning of visual obscuration

Question 24

Non-Arteritic Anterior Ischaemic Optic Neuropathy signs

Answer 24

Hyperaemic disc swelling often few peripapillary splinter shaped haemorrhages
Swelling grad. resolves, pallor after 3-6 weeks

Question 25

Non-Arteritic Anterior Ischaemic Optic Neuropathy treatment

Answer 25

No

Question 26

Arteritic Anterior Ischaemic Optic Neuropathy pathogenesis

Answer 26

Occlusion of posterior ciliary arteries due to giant cell arterities

Question 27

Arteritic Anterior Ischaemic Optic Neuropathy presentation

Answer 27

8th to 9th decade, sudden profound vision loss, periocular pain, transient visual obscuration, flashing lights

Question 28

Arteritic Anterior Ischaemic Optic Neuropathy signs

Answer 28

Severe visual loss; to light perception or worse Strikingly pale oedematous disc over 1-2 months, swelling gradually resolves and optic atrophy ensues

Question 29

Arteritic Anterior Ischaemic Optic Neuropathy management

Answer 29

Refer to ophthalmologist for intravenous steroids to prevent blindness

Question 30

Arteritic Anterior Ischaemic Optic Neuropathy prognosis

Answer 30

poor

Question 31

Papilloedema pathogenesis

Answer 31

Swelling of ONH secondary to raised intracranial pressure

Question 32

Papilloedema signs

Answer 32

Disc hyperaemia, elevation, indistinct margins, | Venous engorgements, peripapillary flame shaped haemorrhages, cotton wool spots

Question 33

Papilloedema management

Answer 33

Refer to ophthalmologist urgently, suspicious of intracranial mass

Question 34

Absolute afferent papillary defect characteristics

Answer 34

Eye complete blind, Both pupils equal in size, affected eye stimulated both no reaction, if norm eye stimulated reacts normally, near reflex is normal1

Question 35

Argyll Robertson Pupil cause and signs

Answer 35

Caused by neurosyphilis, Bilateral small pupils do not react to light Near response normal

Question 36

Adie pupil causes

Answer 36

denervation of the postganglionic supply to the sphincter pupillae and ciliary muscle

Question 37

Adie pupil signs

Answer 37

``` Large regular pupil Direct light reflex: absent/sluggish Consensual light reflex: absent/sluggish Near reflex: slow contrsict, redilation Accomodation: manifest similar tonicity ```

Question 38

Horner syndrome causes

Answer 38

Lesion occur anywhere on sympathetic supply, diff conditions can affect the three different sympathetic neurons. Central preganglionic postganglionic

Question 39

Horner syndrome signs

Answer 39

``` unilateral Mild ptosis Miosis Slight elevation of inferior eyelid Hypochromic heterochromia Reduced ipsilateral sweating normal pupillary reaction to light and near ```