Neuro-opthamology Flashcards
Normal pupils on exam
anisocoria 0-1 mm
anisocoria must be the same in all levels of light
react normal to light and dark
Anisocoria
Pupils different sizes
Sympathetic vs parasympathetic pupillary response
Sypathetic- dilates by radial muscle
Parasympathetic- constricts by sphincter
What symptoms are seen with sympathetic dysfunction?
Small pupil with poor rxn to dark
What symptoms are seen with parasympathetic dysfunction?
large pupil, poor rxn to light
Horner syndrome
sympathetic dysfunction in pupillary reflex
Segmental palsy
Only part of the pupil has been rewired so parts don’t constrict well
Visual field deficits
Describe them from patient’s perspective
Break visual fields into quadrants
If lesion in chiasm: Get lateral half of field loss on both eyes
In left optic radiations (“Meyer’s Loop”): respects vertical meridian but don’t get full loss of half (homonomous- same side on both eyes)
Left inferior occipital: punched out area of fovea is ok but respects vertical and horizontal meridians and is homonymous
Optic nerve deficits
Complaints:
Monocular vision loss (blurred, missing,dim)
Decreased brightness or color vision impaired
Exam: Vision loss (acuity, field, or both) Afferent Pupillary Defect (APD) Color vision loss Abnormal optic nerve (swelling and bleeding)
Afferent pupillary defect
Afferent – prior to synapse in LGN (thalamus)
Detected by swinging flashlight test
Symptoms of eye misalignment
Have binocular diplopiac
Localizing ocular misalignment
Nerve (3,4,6)
Eye (displaced)
Junction, neuromuscular (myasthenia)
Muscle (thyroid, myopathies)
Downbeat nystagmus
- Localizable to cervical-medullary junction
- Not a congenital type of nystagmus
Surgical decompression – improved
