Neurological

Question 1

What most commonly affects the heart and eyes simultaneously?

Answer 1

Vascular disease

Question 2

What are possible causes of CNVI nerve palsy?

Answer 2

Microvascular, raised ICP, tumour, congenital

Question 3

What sign may you see in a CNIV nerve palsy?

Answer 3

Head tilt-due to weak incyclo-torsion

Question 4

What are possible causes of CNIV nerve palsy?

Answer 4

Congenital decompensated, microvascular, tumour, closed head trauma (bilateral)

Question 5

What are possible causes of CNIII nerve palsy?

Answer 5

Microvascular, tumour, aneurysm, MS, congenital

Question 6

What is the likely cause of a painful CNIII palsy?

Answer 6

Aneurysm

Question 7

What is Inter-nuclear Ophthalmoplegia?

Answer 7

A disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction

Question 8

Damage to what causes Inter-nuclear Ophthalmoplegia?

Answer 8

Medial longitudinal fasciculus

Question 9

What are possible causes of Inter-nuclear Ophthalmoplegia?

Answer 9

MS, Vascular, many others

Question 10

What are possible causes of visual field defects?

Answer 10

Vascular disease (CVA), space occupying lesion (SOL), demyelination (MS), trauma (including surgical)

Question 11

What causes visual field defects that are due to optic nerve pathology?

Answer 11

Ischaemic optic neuropathy, optic neuritis (commonly MS), tumours (rare)- meningioma, glioma, haemangioma

Question 12

How does optic neuritis present?

Answer 12

Progressive visual loss, pain behind eye especially on movement, colour desaturation, central scotoma

Question 13

What can cause visual defects at the optic chiasm?

Answer 13

Pituitary tumour, craniopharyngioma, meningioma

Question 14

What visual field defect occurs due to pathology at the optic chiasm?

Answer 14

Bi-temporal field defect

Question 15

What can cause visual defects at the optic tracts and radiations?

Answer 15

Tumours (1’, 2’), demyelination, vascular abnormalities

Question 16

What are the properties of defects relating to the optic tracts and radiations?

Answer 16

Homonomous defects, not spared macula. Quadrantanopia, incongruous

Question 17

What can cause visual field defects at the occipital cortex?

Answer 17

Vascular disease (CVA), demyelination

Question 18

What are the properties of defects relating to the occipital cortex?

Answer 18

Homonomous defect with macula sparing. Congruous

Question 19

What is papilloedema?

Answer 19

Swollen optic discs secondary to raised ICP

Question 20

How does papilloedema occur?

Answer 20

When ICP increases, this is transmitted to the SAS then to the optic nerve. Causes interruptiion of axoplasmic flow and venous congestion leading to swollen discs

Question 21

What is ICP the sum of?

Answer 21

Brain (80%), blood (10%), CSF (10%)

Question 22

What eventually happens to the brain in raised ICP?

Answer 22

Squeezed through foramen magnum, brainstem compresses, patients stops breathing and dies

Question 23

Why do discs swell in malignant HT?

Answer 23

Mechanism poorly understood: maybe failure of ONH autoregulation, or HT-related increased ICP

Question 24

When will ICP increase in CSF pathology?

Answer 24

Obstruction to CSF circulation, overproduction of CSF, inadequate absorption

Question 25

What can cause obstruction of CSF circulation leading to raised ICP disc swelling?

Answer 25

Possibly: stenosis of transverse cerebral sinuses, or increased abdo pressure (often obese patients)

Question 26

What can impair CSF absorption leading to raised ICP and disc swelling?

Answer 26

Possibly: role of vitamin A, microemboli in sagittal sinus blocks CSF absorption

Question 27

What happens if disc swelling becomes chronic?

Answer 27

Swelling subsides, disc becomes atrophic and pale. Loss of visual function occur, blindness may result