Neuro-Ophthomology

Question 1

Etiology of Horners

Answer 1

• First Order or central horners: hypothalamic infarcts; tumor; mesencephalic stroke; Brainstem: ischemia (Wallenberg’s syndrome), tumor, hemorrhage
• Second order Horners (or preganglionic): cervicothoracic cord/spinal root trauma; cervical spondylosis, pulmonary apical tumor (pancoast tumor)
• Third-Order Horners (or postganglionic): superior cervical ganglion (tumor, iatrogenic, etc); carotid artery (dissection, trauma, thrombosis, tumor, etc); base of skull: tumor, trauma; middle ear problems; cavernous sinus (tumor, inflammation, aneurysm, thrombosis, fistula)

Question 2

Adie’s pupil

Answer 2

an Adies pupil is dilated, with segmental contraction and light-near association. Results from interruption of the parasympathetic supply from the ciliary ganglion.

Symptoms include anisocoria, photophobia and blurred vision.

It can be confirmed by demonstrating supersensitivity of the affected pupil to 0.1% pilocarpine, which will produce more contraction in the affected pupil than in the normal pupil.

Question 3

Argyll Robertson pupil

Answer 3

Classically assc’d with syphillis. Usually both pupils are small and irregular, with impaired light reaction and intact near response (light-near dissociation). Pupils also dilate poorly to mydriatic agents.

Question 4

Foster-Kennedy syndrome

Answer 4

refers to ipsilateral optic disc atrophy due to compression by a space-occupying lesion in the frontal lobe, and papulledema in the contralateral optic disk due to increased ICP.