Neurological Diseases Flashcards
Cerebral Palsy
group of problems that affect body movement and posture
non-progressive and usually related to brain injury
Etiology: anoxia during birth, genetic condition, or intrauterine infection
Associated with: seizures, mental retardation, hearing and speech problems
Types of CP
Spastic: 80% - decreased spontaneous movements and increased muscle tone (exaggerated reflex, stiff)
- commando crawl, delayed walking, toe walking
- diplegia, hemiplegia, quadriplegia
Dyskinetic: 15% - problem controlling limb movements
- hypotonia as infant, speech problems, difficulty feeding, and ataxic
Mixed Forms
Vision Issues in CP
relate to severity of CP
Optic Neuropathy in 10% mild CP vs 65% severe CP
Avg VA: 20/100 H > Myopia 55% Accommodation Dysfunction 60% strab (overall ET more common) BUT spastic (XT more common clinically) VFD + poor VMI + CVI
CVI
Cortical/Cerebral Vision Impairment
damage to the BRAIN (not eye)
- detect with MRI/CT
may have normal eye exam but decreased VA
- strong color preference
- movement to see objects
- delayed visual responses
- light gazing
- VF preference
- no visually guided reach
Etiology: any disorder that affects BRAIN
- hypoxia, CVA, infection, structural, metabolic conditions
Nystagmus
rhythmic, biphasic oscillation in eyes due to sign of vision loss, CNS disorder, response to external stimuli, body rotation, or inner ear disorder
unilateral < bilateral
Note the amplitude, frequency, conjugacy, and type
Hx: age of onset, head nodding, head turn, meds (anti-epileptics, drugs, ETOH), development status, birth and family history
Neuro Signs: seizures, poor balance, failure to thrive (develop), large head, vomit, dizzy, HA
Types of Nystagmus
Jerk: fast and slow
Pendulum: equal velocity both ways
Nystagmus Exam
VA with a frosted occluder or high plus lens bc you don’t want to fully occlude (latent)
Motilities in all 9 gazes
Pupils, ON assessment (DFE + CV), OKN, consider MRI
Nystagmus Tx
Correct RE, Prisms (BO to stimulate convergence), Biofeedback, Sx to move eyes to null point, Education, Low Vision
Infantile/Congenital Nystagmus
- onset
- manifestations
onset 2-4 mos old and may improve with age
pendular is classic (can be jerk at endgaze) or jerk
Nystagmus Blockage Syndrome: develop ET and converge eyes with head turn to depress nystagmus
Congenital ET Syndrome: have associated ET from congenital nystagmus
Symptomless
Latent: will appear once 1 eye is covered
OKN Inversion
- normal is eyes follow tape and beat opposite quickly
- congenital: eyes beat in direction of tape
Fixation: worse at distance and better at near bc convergence
Upgaze remains horizontal
Null Point: head tilt with minimal nystagmus
Forms of Infantile/Congenital Nystagmus
Motor Forms: efferent pathway disorder of oculomotor systems involved in fixation (behind eye to brain)
- may be genetic
Sensory Forms: ON abnormalities, Ocular Albinism, Cataracts, tend to be pendular
Acquired Nystagmus
pendular/jerk or see-saw (one up and one down; super rare and caused by midbrain lesion)
Down Beat: cerebellar lesion
Up Beat: cerebellum, medulla, midbrain lesion
Spasmus Nutans can occur
Spasmus Nutans
Triad: Head Tilt (Torticollis) + Head Nod + Monocular or Asymmetrical Nystagmus
*MONOCULAR NYSTAGMUS: ORDER MRI because it can be caused by a tumor in third ventricle or optic chiasm
starts 4-14 mos and resolves by 5 years old (usually benign)
Glioma
APD, Optic Atrophy/Edema, Large Head, Cafe Au Lait (NF1) , Neuro dysfunction
Retinal Disease
DDX for Spasmus Nutans
Achromatopsia (no CV) and Congenital Stationary Night Blindness
Headache
Hx: onset, duration, frequency, location, associated signs, relief?, systemic meds, intensity (1-10)
Visual causes: reading, trying to see far, squinting
- will not wake up with HA, vomit, systemic findings, before lunch, when playing
Exam: history guides testing!!
- Refraction, Binocular + Accommodation Testing if indicated, DFE with attention to ON (SVP and ON edema), VF (VFD)
