Neuro-optho Flashcards
How can you distinguish causes of VA problems?
use pinhole test - if visual acuity improves, likely a refractive rather than neuro issue
What is Adie’s pupil and how can it be demonstrated?
dilated tonic pupil, - give pilocarpine and affected pupil contracts more
What are Argyll Robertson pupils?
small irregular pupils associated with syphillis
What are the most common casues of unilateral optic disk swelling?
optic neuritis, acute ischemic optic neuropathy, orbital compressive lesions
What is Foster Kennedy syndrome?
ipsilateral disk atrophy due to optic nerve compression and papilledema in contralateral optic disk due to increased ICP from frontal lobe tumor
A patient presents with an asymptomatic enlarged blind spot and hyaline bodies on fundus exam. This is..
pseudopapilledma from small hyaline concretions - use CT to see bodies
What is the difference between comitant and incomitant strabismus?
incomitant - degree of misalignment varies with direction of gaze
A patient presents with oblique diplopia worse on down gaze. What is this? What will improve symptoms?
4th nerve palsy - tilting head away from lesion helps
What is the difference between a “phoria” and a “tropia”
tropia - misalignment of eyes when both eyes are opened and binocular vision is possible
phoria - misalignment when binocular vision is not present; does not cause diplopia because eyes are aligned when both are open
What is a one-and-a-half syndrome?
lesion involving PPRF, VIth nerve nucleus and adjacent ipsilateral MLF - patient can only abduct contralateral eye
(inability to adduct = INO)
(causes gaze palsy to ipsilateral side and INO in contralateral gaze)
A patient has an upgaze disturbance. This is..
perinaud’s syndrome - likely caused by pineal tumor compressing dorsal midbrain
What is oculomotor apraxia?
Inability to produce saccades
What conditions are associated with periodic alternating nystagmus?
MS, bilateral blindness, craniocervical junction abnormalities, anticonvulsant toxicity
What conditions are associated with upbeating nystagmus?
lesions of cerebellar vermis, Wernicke’s,
What conditions are associated with a downbeating nystagmus?
spinocerebellar degeneration, MS, familial periodic ataxia, drug intoxication
What are key differences between central and peripheral nystagmus?
peripheral - usually unilateral, unidirectional, never vertical, tinnitus often present, severe vertigo
central - bidirectional, bilateral; mild vertigo
Where are horizontal saccades initiated?
contralateral frontal eye fields, superior colliculus
Where are vertical saccades initiated?
bilateral frontal eye fields or superior colliculus
A young woman with MS develops a severe headache and her BP drops after delivery. This is..
pituitary apoplexy
A patient who has been on chronic corticosteroids for asthma presets with blurred vision and her fundus can’t be visualized. This is..
lens opacity from chronic steroids
A patient has sudden double vision and when she looks to the left, the right eye does not fully adduct and there is nystagmus of the abducting left eye. This is..
right INO
A patient presents pain on movement of her right eye and dimming vision. The fundus shows central scotoma. This isi..
optic neuritis
A 13 year old patient presents with dizziness, slurred speech and double vision. It goes away in 15 minutes and then he has a severe headache and begins vomiting. This is a …
basilar migraine
A 38 year old woman collapses and begins vomiting. Her neck is rigid, she has a dilated left pupil, her left lid droops and her left eye is abducted. This is..
PCOM aneurysm
