Neuro-Opthalmology

Question 1

What are the causes of optic disc swelling

Answer 1

optic neuritis
papilloedema
malignant HTN 
arteritic anterior ischaemic optic neuropathy 
non arteric anterior ischaemic

Question 2

What causes papilloedema

Answer 2

raised ICP causing bilateral swelling (unilateral only if there is preexisting atrophy)

Question 3

what symptoms does papilloedema have

Answer 3

Transient vision blurring and headaches

early = enlarged blind spot 
late = gradual progessive field loss

eventually irreversible atrophy occurs

Question 4

Retinal signs for papilloedema

Answer 4

Splinter haemorrhages
Exudates
Cotton wool spots
Retinal Folds

Question 5

What is Arteric anterior ischaemic optic neuropathy (AION)

Answer 5

inflammation of optic arteries leading to infarction

e.g. temporal arteritis causing optic disc ischaemia/CN2 infarction

Question 6

what are some signs and symptoms of arteritic anterior ischaemic optic neuropathy

Answer 6

increased ESR/CRP

weight loss

body aches

pale/white disc with blurred margins, an obliterated cup and some fundal pallor `

Question 7

how do you treat arteritic anterior ischaemic optic neuropathy

Answer 7

80mg (1-1.5mg/kg) steroids + temporal aa biopsy within 1 week for confirmation

Question 8

what are the consequences for not treating arteritic anterior ischaemic optic neuropathy

Answer 8

eye will die and 2nd one will go within 2-3 weeks

Question 9

what is non-arteritic anterior ischaemic optic neuropathy

Answer 9

obstruction of arteries upstream of the optic arteries due to atherosclerosis (instead of inflammation in AION) causing infarction

Question 10

how does non-arteritic anterior ischaemic optic neuropathy differ to arteritic anterior ischaemic optic neuropathy in presentation

Answer 10

swelling isnt as severe and the visual impairment not as severe - usually only 1/2 the disc swells

ESR/CRP not raised

tend to be diabetic/hypertensive with no other systemic symptoms

Question 11

how do you treat non-arteritic anterior ischaemic optic neuropathy

Answer 11

low dose aspirin

Question 12

what is optic atrophy

Answer 12

optic nerve atrophy
pale disc
loss of surface capillaries
RAPD

Question 13

what is APD and what causes it

Answer 13

no consensual/direct response

disruption in fibres from ganglionic cells to PTN and from PTN to same and contralateral EW nucleas

Question 14

what is RAPD and what causes it

Answer 14

dilation instead of constriction on a pupil when a light is swung between them

asymmetry of CN2 conduction due to atrophy/inflammation