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Neuro online course > neuro-ophtho / otology > Flashcards

neuro-ophtho / otology Flashcards

0
Q

asymmetry or loss of OKN is what?

A

parietal lobe lesion

OKN uses same side of brain to pursue and to correct the saccade to catch the next stripe

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1
Q

pursuit vs saccade brain regions

A

saccades: catch it with contralateral frontal lobe
pursuit: ipsilateral parietal temporal lobe

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2
Q

lesion of fasicle and superior cerebellar peduncle causes what and name of lesion

A

nothnagel: ipsilat CN 3 palsy and cerebellar ataxia

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3
Q

what will a third nerve nucleus lesion give you?

A

right nuclear cn3: loss of CN3 on third side AND gets levator palpebrae nucleus which is single, so both eyes get ptosis, and superior rectus on opposite side will also be affected.

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4
Q

6th and 7th nerve palsy with contralat hemiparesis

A

millard gubler

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5
Q

ipsilat gaze palsy, 5, 7, and horner’s

A

foville’s

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6
Q

where is the vertical gaze center locted

A

near midbrain / CN III nucleus

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7
Q

where is the horizontal gaze center in brain

A

in pons, near CN VI nucleus

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8
Q

area of brain responsible for saccades vs pursuit

A

saccades: contralat frontal lobe (jerk correction / fast phase)
pursuit: ipsilat parieto/occipital lobe (slow phase)

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9
Q

lesion is where when you get an isolated CN 6 and a horner’s

A

small cavernous sinus lesion near the CN 6/ICA w/ sympathetics sparing the wall of the sinus where the other CNs are

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10
Q

how do you differentiate a supranuclear vs brainstem gaze palsy

A

if doll’s eye can move eyes, the lesion is supranuclear

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11
Q

2 main possible causes of a vertical gaze palsy

A
  1. dorsal midbrain / parinaud syndrome

2. PSP (PD + syndrome)

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12
Q

4 components of a dorsal midbrain lesion syndrome?

A
  1. vertical gaze palsy
  2. OKN downgoing, get a convergence/retraction nystagmus
  3. Pupil: convergence response but no light response: light/near dissoc and pupils are BIG
  4. lid retraction
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13
Q

If you get a vertical gaze palsy and convergence retraction nystagmus, but positive doll’s eye movement, what is diagnosis?

A

PSP

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14
Q

bilateral failure of adduction with horizontal gaze with fully abducted other eye beating?

A

INO

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15
Q

complete failure to look right, and when looking left, the right eye doesn’t adduct

A

1.5 syndrome gets the pPRF and CN6 nuclear complex and the MLF

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16
Q

what are the three components of the SNS pathway for pupil dilation

A

1st order: in brainstem
2nd order: C8-T2 at ciliospinal center of Budge to apex of lung and around subclavian artery to superior cervical ganglion
3rd order: along the ICA (in part with CNVI in the cavernous sinusO)

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17
Q

what is Hutchinson sign with zoster lesions?

A

lesion of tip of nose: may indicate involvement of nasociliary branch and means eye is at risk

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18
Q

involvement of mild ptosis with upper and lower lid involved

A

mullers / SNS

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19
Q

what does aproclonidine drop do

A

Horners tests that would dilate the pupil in a Horners even when cocaine would not.

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20
Q

what does hydroxyamphetamine / paradrine drop do

A

horners: will distinguish between 1/2 or 3rd order; dilates only in 1/2nd not benign third

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21
Q

only type of horners usually benign unless what

A

3rd order, unless with pain, in which case worry about carotid dissection

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22
Q

what do you get if you have a Horners and heterochromia

A

congenital issues b/c SNS is also responsible for giving color or iris

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23
Q

vermiform eye movements with light

this pupil is very sensitive to what drop

A

tonic pupil

very sensitive to pilocarbine

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24
Q

what is Adie’s

A

tonic pupil plus loss of DTRs

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25
Q

argyll robertson pupil vs parinaud pupils and adie’s pupils

A

argyll robertson has small pupils.
parinauds and adies have large pupils
all accomodate but don’t really react to light well

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26
Q

think of what with bilateral central visual field defects (3 examples)

A

toxic or genetic

  1. ethambutol
  2. Lebers
  3. NMO/Devics
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27
Q

micro vs macroadenoma

A

10mm

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28
Q

when someone is complaining on intermittent diplopia or blindness without any CN palsy, think what?

A

could be a loss of vision convergence due to bitemporal blind fields overlapping OR loss of intermittent phoria/drift
Think pituitary tumor

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29
Q

bow tie atrophy of fundi seen in what?

A

bitemporal visual field lesions w/ pituitary tumors

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30
Q

where is lesion if you get a large central visual field defect in one eye and a upper temporal field cut (pie in sky) in other eye?

A

large optic nerve lesion that catches the looping fibers: junctional scotoma

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31
Q

lesion that creates visual field defects with wedges / wisps of spared areas?

A

LGN lesion: onion / laminar sparing of layers

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32
Q

pie in the sky field defect is lesion where?

A

inferior temporal optic tract/radiations lesion

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33
Q

increased congruity in visual field defects r/l eyes with lesions where

A

more posterior leads to more congruity

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34
Q

where is the lesion if you get a large homonymous hemianopsia but with an area of far temporal field spared?

A

occipital lobe

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35
Q

far temporal and macular sparing hemianopsia- where is lesion?

A

occipital lobe

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36
Q

where is lesion if you get monocular loss in one eye and half loss in other

A

hemichiasmal: chiasm gives temporal loss, but also get the optic nerve so lose other whole eye

37
Q

central bitemporal hemianopsia where is lesion

A

very back of chiasm only in pre-fixed chiasm variant

38
Q

radial vessels shooting straight out

A

morning glory disk

39
Q

double ring sign on fundo exam

seen when

A

optic nerve hypoplasia

seen in maternal DM, drug/alcohol

40
Q

calcified nodules and very branched vessels on ophtho exam but good vision

A

Drusen

41
Q

see saw nystagmus

A

chiasmal lesion, craniopharyngioma

42
Q

downbeat nystagmus in what conditions (3)

A

lithium, cerebellar ataxia, chiari

43
Q

what part of retina is responsible for central vision

A

macula and fovea in very center of that

44
Q

Rods vs cones in location and function

A

rods: periphery of retina for night vision
cones: near fovea for color

45
Q

what causes a bi-nasal hemianopsia

A

calcified internal carotid arteries w/ b/l lateral compression

46
Q

muscle for eyelid closing and nerve

A

orbicularis oculi by facial nerve

47
Q

muscle for depression and intorsion

A

superior oblique

48
Q

elevation and intorsion

A

superior rectus

49
Q

depression and extorsion

A

inferior rectus
(inferiors extort)
AND IRS makes us depressed (inferior rectus depresses)

50
Q

elevation and extorsion

A

inferior oblique

inferiors extort

51
Q

pathway of pupillary light reflex

A

optic nerve, chiasm, tract
pretectal nuclei
Edinger Westphal nuclei
ciliary ganglion –> short ciliary nerves

(extrageniculate)

52
Q

what colliculus is responsible for generating saccades

A

superior colliculus

53
Q

w/ CN 3 less diplopia looking far or near?

A

less looking far due to impaired convergence (PNS of CN 3)

54
Q

the only cranial nerve that decussates

A

trochlear

55
Q

which eye is bad in a head tilt / trochlear palsy

A

the eye that is elevated in primary gaze and has trouble looking down

56
Q

short vs long ciliary nerves and PNS/SNS

A

short ciliary: PNS: to iris sphincter for pupil constriction and ciliary muscle for accomodation (short makes pupil small)

long ciliary: SNS for pupil dilators (long makes pupil large)

57
Q

where is MLF/ connects what

A

connects abducens nucleus to oculomotor nucleus on opposite side

58
Q

where is lesion in an INO (ie left eye impaired adduction)

A

left MLF

59
Q

lesion causing 1.5 syndrome

A

pontine lesion causing PPRF OR CN6 nucleus AND MLF to be involved

60
Q

PPRF projects where

A

ipsilat CN6 nucleus AND contralat CN3 nucleus thru MLF

61
Q

LGN lesion that gives the homonymous defect w/ spared horizontal sector is often caused by stroke where

A

anterior choroidal artery / lateral geniculate body

62
Q

homonymous hemianopia with macular sparing

A

occipital cortex lesion (cortex looks like C)

63
Q

how can monocular lesion occur with cortical lesion

A

anterior calcarine cortex can cause a moon shaped temporal defect only in one eye

64
Q

posterior commissure important for what eye movement

A

upgaze

65
Q

rostral interstitial nucleus of MLF is important for what

A

downgaze

66
Q

what causes painless vision loss of sudden onset

A

anterior ischemic optic neuropathy

67
Q

poor pupil response to direct light, but responds consenually

A

APD / usually from optic nerve damage anterior to chiasm

68
Q

unilateral ptosis and synkinesis of CNV and III causing eyelid movement with jaw movement

A

marcus gunn jaw winking

69
Q

marcus gunn pupil

A

relative afferent pupillary defect: pupil appears to dilate when light is pointed at it but constricts consensually

70
Q

pinpoint reactive pupils seen with what?

A

pontine lesions

71
Q

riddoch phenomenon

A

person only sees person’s fingers when they are ridonculously wiggling them but not when still

72
Q

triad of spasmus nutans

A
  1. titubation
  2. nystagmus
  3. torticollis
73
Q

decreased visual acuity with increased temp seen in what

A

optic nerve disease: Uhthoff’s phenom

74
Q

lag of upper lid during down gaze

A

von graefe sign in thyrotoxicosis

75
Q

optic nerve coloboma and chorioretinal lacunae

A

aicardi

76
Q

susac’s syndrome

A

branch retinal artery occlusions

77
Q

oculomasticatory myokymia is seen in what disease

A

whipple’s disease

78
Q

ptosis and impaired extraocular movement without diplopia and swallowing issues
dz and what genetics and what pathology

A

oculopharyngeal muscular dystrophy
GCG repeat expansion in gene encoding PABP2 on chr 14
Rimmed vacuoles

79
Q

most common presentation of NARP (Neuropathy, ataxia, retinitis pigmentosa)

A

night blindness

80
Q

pendular convergent-divergent oscillations of eyes w/ movement of jaws and bursts of myoclonus

A

Whipple disease

81
Q

sunflower cataracts

A

Wilson’s disease

82
Q

in labyrinthitis nystagmus is toward which side?

A

unaffected ear

83
Q

how to distinguish between vestibular neuritis and viral labyrinthitis?

A

hearing loss ALWAYS present in viral labyrinthitis

84
Q

main precipitant for bacterial suppurative labyrinthitis?

A

cholesteatoma

85
Q

type of hearing loss with menieres

A

low frequency

86
Q

dx with hearing loss, vertigo, tinnitus, nystagmus away from bad ear

A

labrynthitis

87
Q

what CNs are involved potentially in cerebellopontine angle lesions

A

V1, 7, 8, 9, 10

88
Q

BAERS wave 1 and 2

A

cochlear nerve then cochlear nucleus

89
Q

BAERs wave III and V?

A

III: superior olive
V: Inferior colliculus

90
Q

what will a CN 6 nuclear lesion cause?

A

it causes limited abduction ipsilateral and also adduction of contralat eye through contralat MLF connections

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