Neuro-opthalmology Flashcards
How long do you have to stop driving for if have a TIA?
1 month
Causes of headache (in neuro-ophthalmology)
Migraine
Acute glaucoma
Herpes Zoster virus
GCA
Features of acute glaucoma
Fixed dilated pupil
Red eye
Vomiting
Presentation of GCA
Headache
Jaw claudication / Jaw pain when eating
Scalp tenderness
What type of pain is claudication?
Ischaemic
What is noticed with HZV in terms of its presentation on the face/head?
Headache before the rash
Types of reduced vision
Transient
Vascular
Definition of amaurosis
Total vision loss that lasts a few seconds, with no visible changes in the eye
What does GCA stand for?
Giant cell arteritis
Common cause of transient reduced vision
TIA
Who commonly gets amaurosis?
Elderly
Common cause of vascular reduced vision
Migraine
How long does reduced vision due to migraine usually last?
20 minutes
Causes of reduced vision due to the anterior segment
Cornea; scar
Lens; cataracts
Causes of reduced vision due to the posterior nerve
Optic nerve
How is visual acuity scored?
X/Y
X = distance reading chart from
Y = distance a normal person can read from
What is a normal visual acuity?
6/6
If cannot read the Snellen chart, what is done?
- Move closer
- Finger counting
- Movements
- Light
Where is the damage when the patient presents with a homonymous hemianopia?
Damage after the optic chiasm
Where is the damage when the patient presents with an afferent pupillary defect?
Damage before optic chiasm
Where is there damage if there is only a defect in one eye?
Damage before the chiasm
Where is the damage if the patient presents with bitemporal hemianopia?
Damage at the optic chiasm
What causes a homonoymous hemianopia?
Cerebrovascular event
What type of eye is a hypermetropic eye?
Short eye
Long sighted
What type of eye is a myotropic eye?
Long eye
Short sighted
Causes of a swollen optic nerve head
Systemic HTN Papilloedema Anterior ischaemic optic neuropathy Central retinal vein occlusion (CRVO) Optic nerve head drusen Hypermetropia
If a swollen optic nerve head is caused by systemic HTN, what is usually present?
Swollen optic nerve head in BOTH eyes
Presentation of papilloedema
Bilateral swollen optic nerve heads
Headache
Increased IOP
Normal vision
Pathology of optic nerve drusen
Hyaline deposits (drusen) deposits in the optic nerve Pseudopapillodema
Pathology of optic nerve swelling in hypermetropia
NOT ACTUALLY SWOLLEN
just looks swollen just looks it due to its short eye
What does optic nerve drusen look like on USS?
Refractile
What does optic nerve drusen look like on CT?
A bright lesion
What is optic neuritis?
Optic nerve head inflammation
Causes of optic neuritis
MS Alcohol/tobacco Infective Syphillis (rare) Lyme (rare)
Presentation of optic neuritis in MS
Subacute vision loss over days - weeks
Pain on eye movement
Red desaturation
What % of optic neuritis due to MS are retrobulbar? And what does this result in?
65%
The optic nerve head looks normal
In what time frame does vision improve in due to optic neuritis from MS?
1 month
What % of patients with optic neuritis will develop MS after 15 years?
50%
What % of patients with optic neuritis will develop MS after 15 years if there are no lesions on the MRI?
25%
What does AION stand for?
Anterior ischaemic optic neuropathy
Presentation of AION
Pale optic nerve head
Sudden visual loss
Sudden severe pain
What artery supplies the optic nerve head?
Anterior ciliary artery
Treatment of non inflammatory AION
No treatment
Causes / types of AION
GCA
Non inflammatory
Who gets GCA causing AION?
Older - 70s
Who gets non inflammatory AION?
Younger - 60s
Risk factors and assosiations
Will the vision loss in the effected eye of GCA recover?
No
What % of the other eye will be affected in GCA if untreated?
95%
Why can a biopsy for GCA be -ve even if have the disease?
Skip lesions
Definition of anisocoria
Different sized pupils
Which pupil is abnormal in anisocoria?
The pupil that doesn’t change in shape
Definition of Adie’s pupil?
Big pupil with delayed constriction in response to light
What is damaged in Adies pupil?
Efferent pathway
What is the damage in Horners syndrome?
Sympathetic pathway
Causes of horners syndrome
CVA
Neck trauma
Demyelination
Syringomyelia
Presentation of horners syndrome
Miosis
Ptosis
Anhidrosis
Definition of myosis
Constriction of the pupil
Definition of anhidrosis
Loss of sweating from the face
What is painful horners syndrome caused by? What may this cause?
Carotid artery dissection
May cause a stroke
What is the muscle that closes the eyelid?
Obicularis
Causes of diplopia
Nerve palsy
Thyroid eye disease
Myasthenia gravis
Stroke
What type of diplopia do you get with a 3rd or 4th nerve palsy?
Horizontal
What type of diplopia do you get with a 4th nerve palsy or a thyroid eye disease?
Vertical
Pathology of thyroid eye disease causing diplopia
Thickening and stiffening of muscles
Muscles can compress optic nerve and can make you lose vision
What is usually done when there is a 3rd nerve palsy? Why? What may some of these patients develop?
Imagine
Concern that it is due to an aneurysm in the posterior communicating artery
May develop a SAH
Eye features of myasthenia gravis
Variable diplopia
Ptosis
What can be raised in myasthenia gravis?
ACh receptor antibodies
Definition of laglopthalmos
Inability to completely close the eyelids
What happens to the eyeball when the eyes close? Why does this happen? Does this happen in everyone
The eye rolls up
To protect the corneal surface
No, does not happen in everyone
When there is a facial nerve palsy, where should you look?
Ear
Pathology of lid retraction
Overactive sympathetic system
Common cause of lid retraction
Thyroid eye disease
