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Neurology > Neuro-ophthalmology - Conditions > Flashcards

Neuro-ophthalmology - Conditions Flashcards

1
Q

What are the common signs of optic nerve dysfunction?

A

Decrease in visual acuity
Dyschromatopsia - visual colour impairment
Visual field defects
Diminished contract sensitivity
Relative afferent pupillary defect (RAPD)

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2
Q

What can cause optic neuritis?

A

Demyelinating diseases e.g. MS

Infections

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3
Q

Clinical features of MS

A

Sensory loss - numbness
Spinal cord symptoms - muscle cramping & weakness
Autonomic features - bladder, bowel & sexual dysfunction
Cerebellar - tremor + dysartyhria + ataxia (Charcot’s triad)
L’hermitte sign - electrical shock on neck flexion
Uhthoff phenomenon - worsening of symptoms due to increase in temp e.g. hot shower
Optic neuritis - USUALLY IS THE PRESENTING COMPLAINT
Nystagmus

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4
Q

Ix Optic neuritis and what you will see if you do the investigations in an affected pt

A

MRI - demyelinating plaques

Lumbar puncture - Oligoclonal bands

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5
Q

Tx Optic neuritis

A

IV methylprednisolone + Oral prednisolone

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6
Q

Aetiology of Anterior Ischaemic Optic Neuropathy (AION)

A

Damage to the optic nerve as a result of ischaemia

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7
Q

Cause of NON-arteritic AION

A 
Occlusion of short posterior ciliary artery due to:
Hypertension
Diabetes 
Sleep apnoea
Optic disc anomaly
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8
Q

Cause of arteritic AION

A

Giant cell arteritis - this occludes the short posterior ciliary artery

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9
Q

What is the difference in vision loss between arteritic and non-arteritic AION ?

A 
Arteritic = painful
Non-arteritic = painless
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10
Q

What happens to the optic disc in arteritic/non-arteritic AION?

A

Arteritic - Chalky-white diffuse swollen disc

Non-arteritic - disc swelling

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11
Q

Ix of arteritic AION

A

ESR, CRP, temporal artery biopsy

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12
Q

Tx of arteritic/non-arteritic AION

A

Arteritic - high dose systemic steroid IV methylprednisolone or oral prednisolone + aspirin

Non-arteritic - treat cause

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13
Q

Aetiology of papilloedema

A

Optic disc swelling secondary to elevated intracranial pressure

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14
Q

Clinical features of papilloedema

A

Elevated ICP symptoms - headache, N&V
Transient visual loss
Enlarged blind spot
Optic disc signs - hyperaemia and blurred margins of optic disc (early)
Swelling and elevation of the whole optic disc with peripaillary splinter haemorrhages (late)

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15
Q

Aetiology of Horner’s syndrome

A

lesion in the sympathetic pathway

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16
Q

3 classic symptoms of Horner’s syndrome

A

Ptosis
Miosis
Ipsilateral anhidrosis

17
Q

Causes of Horner’s syndrome

A

Stroke
Pancoast tumour
Carotid artery dissection
Cluster headache

18
Q

Ix Horner’s syndrome

A

Give apraclonidine - a receptor-1 agonist causing little pupillary dilation in horner’s pupil but will significantly dilate the unaffected eye

CT/MRI used to confirm any tumours or artery dissection

19
Q

What is Adie’s Pupil?

A

Loss of postganglionic parasympathetic innervation to the iris sphincter and ciliary muscle
Unilateral
Occurring in young females

20
Q

Clinical features of Adie’s pupil

A

Anisocoria (affected pupil is larger)
Blurring on near vision
Light reflex absent & Near reflex is slow

21
Q

Ix Adie’s pupil

A

Slit lamp

0.125% topical pilocarpine in both eyes - adie’s pupil constricts while normal pupil doesn’t

22
Q

What is Argyll Robertson pupil?

A

Bilateral irregular small pupils

Both pupils don’t react to light - they do constrict normally on accomadation

23
Q

Pilocarpine does cause constriction of pupils. T/F?

A

F. It does NOT. (opposite of adie’s)

24
Q

Clinical feature of 3rd nerve palsy

A

Ptosis
Down and out eye
Ophthalmoplegia (only abduction of eye is fully normal)
Dilated pupil and accommodation abnormality

25
Q

What medical issues could cause 3rd nerve palsy?

A

Diabetes and Hypertension

26
Q

Clinical features of 4th nerve palsy?

A

Vertical diplopia - worse walking downstairs or looking down
Hypertropia
Depression of eye limited
Head tilt

27
Q

Clinical features of 6th nerve palsy?

A

Horizontal double vision - worse on looking at distant targets
Esotropia in primary position
Abduction is limited

28
Q

Cause of 6th nerve palsy

A

Diabetes
Hypertension
Increased ICP

29
Q

What is myasthenia gravis

A

Autoimmune disease of acetylecholine receptors at post-synaptic neuromuscular junctions
F>M
Affects voluntary muscles
Occular problems are usually the presenting complaint

30
Q

Clinical features of myasthenia gravis

A

Ptosis - bilateral
Lid twitch
Diplopia
Weakness of muscles of facial expression

31
Q

Ix Myasthenia

A

Ice test - ptosis improves after 2 mins
Antibodies - Anti-ACh receptor antibody and anti-muscle specific kinase (MUSK) antibody
Electromyography and muscle biopsy
Imaging of thorax - can reveal thymoma which is associated with myasthenia (tumour)

32
Q

Tx Myasthenia Gravis

A

Pyridostigmine (anticholinesterase), steroids & immunomodulators
Surgery if thymoma present

33
Q

Is neurofibromatosis autosomal dominant or recessive?

A

Dom

34
Q

Clinical features of neurofibromatosis?

A

Neurofibromas
Café au lait spots
Axillary freckling

Ophthalmic features:

  • Optic nerve glioma
  • Bilateral lisch nodules (harmless, don’t affect vision)
  • Plexiform neurofibromas of the eyelid - ‘bag of worm’ sensation
35
Q

NF 2 is more common than NF 1? T/F

A

F. NF1 is more common

36
Q

What is in the cavernous sinus and at what location within the sinus?

A

Lateral wall contains CN 3,4,5 (V1 ,V2)

Internal carotid artery & CN6 pass THROUGH the cavernous sinus

37
Q

Clinical features and the reasoning behind them

A

Ptosis & ophthalmoplegia (paralysis of the muscles within or surrounding the eye) - due to compression of CN 3,4,6
Loss of corneal reflex - due to V1
Maxillary sensory loss - due to V2
Horner’s syndrome - due to involvement of internal carotid ocular sympathetics
Proptosis & periorbital swelling - due to increased venous pressure in the veins draining the orbit

38
Q

Causes of cavernous sinus syndrome?

A 
Infections
Tumours
Cavernous sinus thrombosis 
Internal carotid aneurysm 
Carotid-cavernous fistula

Neurology (15 decks)

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