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Extra eye > Neuro-phthalmology > Flashcards

Neuro-phthalmology Flashcards

1
Q

Tell me about arteritic AION
https://www.reviewofophthalmology.com/CMSImagesContent/2010/10/1_14712_0.gif

A
  • most often caused by GCA
  • chalky white optic disc
  • gradual headache and scalp tenderness, sudden vision loss
  • do bloods (CRP/ ESR), temporal artery biopsy
  • give steroids
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2
Q

Tell me about non-arteritic AION

A
  • HTN and T2DM
  • sudden headache and vision loss
  • segmental hyperaemia of disc and splinter haemorrhages
  • exclude GCA
  • treat underlying cause
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3
Q

Leber hereditary optic neuropathy

A

mitochondiral
boys 10-30
Triad
1. Disc pseudo-oedema
2. peripapillary telangiectasia
3. Tortuosity of the medium sized retinal arterioles
- optic disc atrophy later
- centrocaecal scotoma

Ix - genetic testing and OCT (optic disc oedema or atrophy in late)

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4
Q

Nutritional optic neuropathy aka tobacco-alcohol amblyopia

A

causes:
- vitamin B, copper, folate deficiency
- medications e.g. amiodarone, ethambutol, sildenagil
- alcohol and smoking

Sx - gradual ↓ VA, cetrocaecal scotoma, dyschromatopsia

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5
Q

Papilloedema

A
  • Hyperaemia and blurred margins
  • Swelling and elevation of the whole optic disc with peripapillary haemorrhages
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6
Q

Features of raised ICP

A
  • headache, worse in the morning ± vomiting
  • pulsatile tinnitus
  • unilateral or bilateral transient vision loss
  • enlarged blind spot
  • CN VI palsy
  • Cushing reflex (bradycardia, bradypnoea, hypertension)
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7
Q

Optic disc coloboma

A

Defect in embryonic fissure closing
- Associated with Goldenhar syndrome
- Glistening white bowl excavation of optic disc (often in inferior part, hence superior visual field defect)

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8
Q

Morning glory anomaly

A

Congenital optic disc malformation
- funnel shaped excavation of optic disc
- vessels originate from periphery of optic disc
- retinal detachment

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9
Q

Optic nerve hypoplasia

A
  • Double ring sign
    RF: genetic disease, maternal smoking and alcohol and recreational drugs
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10
Q

Horner syndrome

A
  1. partial ptosis
  2. miosis
  3. anhydrosis (not present in 3rd order neurone lesion)
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11
Q

Causes of Horner syndrome

A
  1. primary neurone - lateral medullary lesion or syringomyelia
  2. secondary neurone - Pancoast tumour, neck trauma
  3. Tertriary neurone - internal carotid artery dissection (painful)
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12
Q

Horner syndrome investigations

A
  1. Topical apraclonidine - alpha 1 and 2 agonist -> dialation due to denervation hypersensitivity
  2. Topical cocaine - inhibits neuroadrenaline reuptake. MYDRIASIS IN NORMAL PEOPLE BUT NOT IN HORNER!!!
  3. Hydroxymethamphetamine - stimulates NA release from post-ganglionic neurone. Does not dialate in 3rd order neurone lesion
  4. TOPICAL ADRENALINE - MYDRIASIS 3&raquo_space;»2 , 1
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13
Q

Holmes Adie pupil anisocria

A

Unilateral, dialated pupil
constricts in response to light and accommodation
Constriction in accommodation to near object&raquo_space; light
cause: loss of postganglionic parasympathetic nerves to iris and ciliary muscle

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14
Q

Holmes Adie investigations

A

Slit lamp
Topical pilocarpine - constriction due to denervation hypersensitivity

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15
Q

Argyll Robertson anisocria

A

Bilateral irregular small pupils
No response to light
But constrict in accommodation (near object)
Cause: DM, neurosyphilis

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16
Q

Anterior chiasmatic lesion

A

Willebrand’s knee (inferonasal fibres)
Junctional scotoma: ipsilateral anopia + contralateral supratempral VF defect
cause: tuberculum sellae meningioma

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17
Q

Bitemporal superior quadranopia

A

pituitary adenoma

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18
Q

Bitemporal inferior quadranopia

A

Craniopharyngioma

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19
Q

Bitemporal hemianiopia

A

Pituitary adenoma
Craniopharyngioma
Large anterior communicating artery aneurysm

20
Q

Binasal hemianopia

A

Bilateral internal carotid aneurysm

21
Q

CN III palsy, pupil sparing

A

HTN and DM
Pupillomotor fibres are located superficially, supplied by pial blood vessels

22
Q

CN III palsy, pupils involved

A

Pupillomotor fibres involved
Surgical, trauma, uncal hernication, posterior communicating artery aneurysm

23
Q

Vascular syndromes of CNIII palsy

A
  1. Weber’s syndrome
  2. Benedikt syndrome
  3. Nothangel synrome
  4. Claude syndrome (Benedikt + Nothangel syndromes)
24
Q

Weber’s syndrome

A

ipsilateral CNiii palsy
contralateral hemiparesis

25
Q

Benedikt syndrome

A

Ipsilateral CNIII palsy
Contralateral hemiataxia and hemitremor (damage to red nucleus)

26
Q

Nothangel syndrome

A

ipsilateral CNIII palsy
Ipsilateral cerebellar ataxia (damage to superior cerebellar peduncles)

27
Q

when is CNIV palsy worse

A

ipsilateral head tilt

28
Q

CNIV palsy compensatory head position

A

contralateral head tilt

29
Q

Internuclear ophthalmoplegia

A
  • damage to MLF
    impaired ipsilateral adduction + contralateral horizontal nystagmus
30
Q

Parinaude syndrome

A
  • often due to pinealoma
  • Supranuclear gaze palsy (vertical gaze palsy) - sunsetting downwards gaze
  • Collier sign (lid retraction)
  • convergence retraction nystamus
31
Q

Progressive supranuclear palsy

A

Vertical gaze palsy
- Slowing of vertical saccades
- Postural instability
- Parkinsonism (Parkinson’s plus)

32
Q

2 types of physiological nystagmus

A
  1. End-point nystagmus (nystagmus at extreme gaze)
  2. Optokinetic nystagmus due to fast moving repetitive objects
33
Q

Cogan lid twitch

A

In MG
Brief upshoot of lid after making patient look downwards then upwards

34
Q

Myotonic dystrophy

A
  • AD, trinucleotide repeats
    Features:
    1. unable to relax
    2. polymorphic lens opacities - christmas tree cataract
    3. ophthalmoplegia
    4. Ptosis

*frontal baldness, testicular atrophy, cardiomyopathy

35
Q

Kearns Sayre syndrome

A

mitochondrial. upto 20
Histopathology - ragged red fibres due to high mitochodnria
triad:
1. bilateral ptosis and ophthalmoplegia
2. pigmented retinopathy ‘salt and pepper’
3. cardiac conduction defect

36
Q

Miller Fisher syndrome

A

Rare variant of Guillain Barre syndrome
tetrad:
ataxia, areflexia, ophthalmoplegia and facial diplegia

37
Q

NF1

A

AD chromosome 17
features
- cafe au lait
- axillary freckling
- optic nerve glioma
- Lisch nodules
- ‘bag of worm sensation’ neurofibroma
- choroidal naevi

38
Q

NF2

A

AD chromosome 22
- meningiomas
- Bilateral acoustic schwannoma
- posterior subcapsular cataracts

39
Q

Tuberous Sclerosis

A

AD
- Ash leaf
- angiofibroma
- seziures and cognitive impairment
- intracranial or retinal astrocytic hamartomas

40
Q

Benign essential blepharospasm

A

females, 60s

mx: articial tears for dry eyes, botox injection in orbicularis occuli (ptosis, dry eyes), surgical myectomy

41
Q

Posterior chiasm lesion

A

Paracentral scotoma (macula fibres cross posteriorly)

42
Q

Gradenigo syndrome

A

otitis media + CN6 palsy - spread of infection to apex of petrous bone
Dorello canal in petrous bone

43
Q

Test for stereopsis

A

Titmus test
Synoptophore
TNO and Lang

44
Q

Test for sensory fusion

A

worth 4 dot
Bagolini glasses

45
Q

Test for motor fusion

A

Prism test (Risley)

Extra eye (7 decks)

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