Neuro-opthalmology

Question 1

What increases raised intracranial pressure

Answer 1

Valsalva manoeuvres: coughing, straining, bending forwards, nausea, vomiting

Question 2

Headaches in Giant Cell Arteritis (GCA)

Answer 2

Often diffuse rather than on temple, scalp tenderness, Jaw claudication, visual disturbance

Question 3

Symptoms of GCA

Answer 3

Loss of vision, transint or persistent diplopia, bilateral visual loss

Question 4

Confrontation of visual fields

Answer 4

Involves patient looking directly at your eye or nose and testing each quadrant in the patient’s visual field by having them count the number of fingers that you are showing. Test done one eye at a time.

Question 5

Hemianopia

Answer 5

Defect involving half of the visual field

Question 6

Quadrantanopia

Answer 6

Defect involving only a superior or inferior quadrant

Question 7

Homonymous

Answer 7

Defect affects same half of field in both eyes

Question 8

Altitudinal

Answer 8

Defects that are either superior or inferior that do not cross the vertical midline

Question 9

Assessing Optic nerve function for colour

Answer 9

Ishihara Plates, using red objects

Question 10

Route of CN2: Optic nerve

Answer 10

From eye to brain (afferent)

Question 11

Route of CN3: Oculomotor

Answer 11

From brainstem to eye muscles controlling eye movement

Question 12

Anisocoria

Answer 12

Difference in right and left pupil size

Question 13

Argyl-Robertson pupil aka Prostitutes pupil

Answer 13

When pupils reduce in size on a near object but don’t constrict to bright light

Question 14

Adie’s pupil

Answer 14

Slow response of pupils constricting to light

Question 15

Argyl-Robertson can be a sign of what

Answer 15

Neurosyphillis or diabetic neuropathy

Question 16

Types of patients that present with Aidie’s pupil

Answer 16

Females with absent knee or ankle jerks and impaired sweating

Question 17

Relative Afferent Pupillary Defect

Answer 17

Condition in which pupils respond differently to light stimuli shone in one eye. Marker for UNILATERAL or ASYMMETRIC optic nerve disease.

Question 18

4 symptoms of Horner’s Syndrome

Answer 18

Miosis, ptosis, anhidrosis, enophthalmos

Question 19

Where is the defect if anisocoria is greater in light

Answer 19

Parasympathetic

Question 20

Where is the defect if anisocoria is greater in dark

Answer 20

Sympathetic

Question 21

Eye movement terminology

Answer 21

Elevation, depression, intorsion, extorsion, adduction, abduction

Question 22

3rd Nerve Palsy

Answer 22

Ptosis, diplopia

Question 23

4th Nerve Palsy

Answer 23

Unilateral case: face tilt to opposite side of lesion
Bilateral case: Chin depression
Causes: Trauma, microvasculature, decompoensation of old lesion

Question 24

6th Nerve Palsy

Answer 24

Eye turns out as lateral rectus muscle involved, raised ICP in bilateral cases, GCA, common in HPT and diabetics

Question 25

What do we suspect with 3rd Nerve Palsy involving pupil

Answer 25

Intracranial aneurysm until proven otherwise

Question 26

Headaches, Optic nerve swelling, raised ICP

Answer 26

Papilloedema

Question 27

Headaches, optic nerve swelling, symptoms of GCA

Answer 27

Ischaemic optic neuropathy

Question 28

Who to always ask about when GCA symptoms presents

Answer 28

Those over 50 yo with diplopia or optic nerve swelling

Question 29

Central Retinal Vein Occlusion (CRVO)

Answer 29

A blockage of the small blood vessels that carry blood away from the retina, located in the back of the eye. The blockage causes the vein to leak blood and excess fluid into the macula

Question 30

Most common retinal vascular disorder

Answer 30

1. Diabetic Retinopathy

2. CRVO

Question 31

Risk factors for CRVO

Answer 31

High BP, arteriosclerosis, diabetes, and glaucoma

Question 32

Symptoms of CRVO

Answer 32

Sudden painless vision loss in one eye that can become worse over several hours or days

Question 33

Treating CRVO

Answer 33

Steroids for macular oedema panretinal photocoagulationis used to prevent neovascular glaucoma: uses laser to prevent growth of abnormal vessels

Question 34

Presbyopia

Answer 34

loss of accommodation with age