Neuro-opthalmology Flashcards
What increases raised intracranial pressure
Valsalva manoeuvres: coughing, straining, bending forwards, nausea, vomiting
Headaches in Giant Cell Arteritis (GCA)
Often diffuse rather than on temple, scalp tenderness, Jaw claudication, visual disturbance
Symptoms of GCA
Loss of vision, transint or persistent diplopia, bilateral visual loss
Confrontation of visual fields
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.
Hemianopia
Defect involving half of the visual field
Quadrantanopia
Defect involving only a superior or inferior quadrant
Homonymous
Defect affects same half of field in both eyes
Altitudinal
Defects that are either superior or inferior that do not cross the vertical midline
Assessing Optic nerve function for colour
Ishihara Plates, using red objects
Route of CN2: Optic nerve
From eye to brain (afferent)
Route of CN3: Oculomotor
From brainstem to eye muscles controlling eye movement
Anisocoria
Difference in right and left pupil size
Argyl-Robertson pupil aka Prostitutes pupil
When pupils reduce in size on a near object but don’t constrict to bright light
Adie’s pupil
Slow response of pupils constricting to light
Argyl-Robertson can be a sign of what
Neurosyphillis or diabetic neuropathy
Types of patients that present with Aidie’s pupil
Females with absent knee or ankle jerks and impaired sweating
Relative Afferent Pupillary Defect
Condition in which pupils respond differently to light stimuli shone in one eye. Marker for UNILATERAL or ASYMMETRIC optic nerve disease.
4 symptoms of Horner’s Syndrome
Miosis, ptosis, anhidrosis, enophthalmos
Where is the defect if anisocoria is greater in light
Parasympathetic
Where is the defect if anisocoria is greater in dark
Sympathetic
Eye movement terminology
Elevation, depression, intorsion, extorsion, adduction, abduction
3rd Nerve Palsy
Ptosis, diplopia
4th Nerve Palsy
Unilateral case: face tilt to opposite side of lesion
Bilateral case: Chin depression
Causes: Trauma, microvasculature, decompoensation of old lesion
6th Nerve Palsy
Eye turns out as lateral rectus muscle involved, raised ICP in bilateral cases, GCA, common in HPT and diabetics
What do we suspect with 3rd Nerve Palsy involving pupil
Intracranial aneurysm until proven otherwise
Headaches, Optic nerve swelling, raised ICP
Papilloedema
Headaches, optic nerve swelling, symptoms of GCA
Ischaemic optic neuropathy
Who to always ask about when GCA symptoms presents
Those over 50 yo with diplopia or optic nerve swelling
Central Retinal Vein Occlusion (CRVO)
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
Most common retinal vascular disorder
- Diabetic Retinopathy
2. CRVO
Risk factors for CRVO
High BP, arteriosclerosis, diabetes, and glaucoma
Symptoms of CRVO
Sudden painless vision loss in one eye that can become worse over several hours or days
Treating CRVO
Steroids for macular oedema panretinal photocoagulationis used to prevent neovascular glaucoma: uses laser to prevent growth of abnormal vessels
Presbyopia
loss of accommodation with age
