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Neurology > Neurology eye (delta) > Flashcards

Neurology eye (delta) Flashcards

1
Q

Inferior obqlie action

A

Extorsion
Elevation
Abduction

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2
Q

Inferior rectus action

A

Depression

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3
Q

Medial rectus action

A

Adduction

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4
Q

Superior rectus action

A

Elevation

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5
Q

LPS action

A

Retraction of eyelid

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6
Q

Superior oblique action

A

Incyclotorsion
Depression
Abduction

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7
Q

Lateral rectus action

A

Abduction

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8
Q

CNs that originate from midbrain

A

Oculomotor

Trochelar

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9
Q

CNs that originate from pons

A

Trigeminal

Abducens

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10
Q

CNs at cerbellopontine angle

A

Facial nerve

Vestibulocochlear

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11
Q

CNs that originate at medulla

A

Glossopharyngeal
Vagus
Spinal accessory
Hypoglossal

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12
Q

Accomodation

A

Increase in lens curvature; ciliary muscle contracts leading to relaxation of suspensory ligaments of lens
Constriction of pupils; activation of sphincter pupillae
Eye convergence medially

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13
Q

Signs of optic nerve dysfunction

A 
Decrease in VA
Dyschromatopsia; red first
Visual field defects
Diminished contrast sensitivity 
RAPD
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14
Q

Systemic clinical features of MS

A

Sensory loss
Motor spinal cord symptoms
Autonomic; bladder, blower and sexual dysfunction
Cerebellar; tremor + dysarthria + ataxia
L’hermitte sign; electrical shock on neck flexion
Uhthoff phenomenon; worsening of symptoms due to increase in temperature

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15
Q

Opthalmic features of MS?

A

Optic neuritis; unilateral pain exacerbated by eye movement, decreased VA (central scotoma), dyschromatopsia, RAPD
INO
Nystagmus

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16
Q

What can be seen on ix for MS?

A

Demyelinated plaques on MRI

Oligoclonal bands in CSF on LP

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17
Q

Tx for optic neuritis

A

IV methylprednisolone followed by PO prednisolone

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18
Q

What is neuromyelitis optica?

A

Demyelinating disorder characterized by bilateral severe optic neuritis and transverse myelitis in 3 or more vertebral columns
Causes muscle weakness, increased tone and spasm

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19
Q

What can be seen on investigation of neuromyelitis optica?

A

IgG antibody against AQP4

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20
Q

What is AION?

A

Damage to optic nerve as a result of ischaemia

Can be non-arteritic or caused by giant cell arteritis

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21
Q

Presentation of non-arteritic AION

A

Less than 50
RF: idiopathic, hypertx, diabetes, sleep apnoea, disc anomaly
Occlusion of short posterior ciliary artery
Sudden, painless, unilateral visual loss
Inferior altitudinal VF defect
Disc swelling
Ix; BP, BG, exclude GCA
Treat cause

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22
Q

Presentation of GCA

A

Older than non-arteritic
GCS of short posterior ciliary artery
Sudden, painful, unilateral severe visual loss
Disc; chalky white, diffusely swollen, optic atrophy
Assoc sy; scalp tenderness, headache, jaw claudication
Ix; ESR, CRP, temporal artery biopsy
Tx; high dose IV methylprednisolone

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23
Q

What is papilloedema?

A

Optic disc swelling due to elevated ICP

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24
Q

Clinical features of papilloedema

A

Elevated ICP sy; headache (worse in morning), N+V, pulsatile tinnitus, deterioration of consciousness
Transient visual loss with a duration of seconds
Enlarged blind spot

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25
Q

Signs of papilloedema on fundoscopy

A

Hyperaemia and blurring of disc margins

Swelling and elevation of optic disc with peripapillary sphincter haemorrhage

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26
Q

What is horner’s syndrome?

A

Lesion to symp pathway

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27
Q

Hallmarks of horner’s syndrome

A

Ptosis
Miosis
Ipsilateral anhydrosis

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28
Q

What causes horner’s syndrome

A 
Stroke
Syringomyelia
Pancoast tumour
Carotid aneurysm
ICA dissection 
Cluster headache
Cavernous sinus lesion
29
Q

What does a painful horner’s syndrome direct you towards?

A

Carotid/ ICA dissection

30
Q

What can be used to confirm hroner’s syndrome?

A

Apraclonidine; will cause pupillary dilation in the horner’s pupil but normal pupil will be unaffected

31
Q

What is lateral medullary syndrome (wallenberg’s syndrome)?

A

Ischaemia of lateral part of medulla due to blockage of posterior inferior cerebellar artery or vertebral artery

32
Q

What are the clinical features of wallenberg’s syndrome?

A

Damage to vestibular nucleus; vertigo, vomiting, nystagmus
Damage to descending symp tract; ipsilateral horner’s
Damage to spinal trigeminal; ipsilateral loss of pain/temp and loss of corneal reflex
Damage to spinothalamic tract; contralateral loss of pain/ temp in trunk and limbs
Dysphagia
Horseness

33
Q

What is adie’s pupil?

A

Loss of postganglionic parasymp innervation to iris sphincter and ciliary muscle

34
Q

What are the clinical features of adie’s pupil?

A

Dilation and blurring on near vision

Light reflex absent or slow

35
Q

What is Holmes-Adie syndrome?

A

Diminished or absent deep tendon reflex of lower limbs + adie’s pupil +/- orthostatic hypotension

36
Q

Ix for Adie’s pupil

A

Slit lamp

0.125% topical pilocarpine. Adie’s pupil will constrict while normal pupil won’t

37
Q

What causes argyll robertson pupil?

A

Neurosyphilis

Diabetes

38
Q

What are the clinical features of argyll robertson pupil?

A

Bilateral, irregularly small pupils
Will NOT react to light
Normal accommodation

39
Q

Will argyll robertson pupils constrict to 0.1% pilocarpine?

A

No

40
Q

Causes of chiasmatic lesions?

A

Large pituitary adenomas
Craniopharyngiomas
Tuberculum sellae meningioma

41
Q

What visual field defects will chiasmatic optic nerve cause?lesions

A

Bitemporal hemianopia

42
Q

What will visual field defects will lesions at the optic tracts cause?

A

Contralateral homonymous hemianopia

43
Q

What visual field defects will lesions at the optic radiations cause?

A

Temporal; contralateral superior homonymous quadrantanopia
Parietal; contralateral inferior homonymous quadrantanopia
Main radiations; contralateral homonymous hemianopia

44
Q

What visual field defects will lesions at the occipital cortex cause?

A

Contralateral homonymous hemianopia with macular sparing

Congruous homonymous macular defects if posterior head injury

45
Q

Features of 3rd nerve palsy?

A

Ptosis
Abduction and depression with ophthalmoplegia
Dilated pupil and accomodation abnormality

46
Q

What causes a painful 3rd nerve palsy?

A

Posterior communicating artery anurysm

47
Q

Causes of 3rd nerve palsy?

A

Diabetes and hypertex; affect blood supply to nerve
Posterior communicating artery aneurysm (painful)
Trauma
Uncal herniation

48
Q

What is weber’s syndrome?

A

Stroke affecting ventral midbrain; characterised by ipsilateral 3rd nerve palsy with contralateral hemiapresis

49
Q

What is benedikt’s syndrome?

A

Form of stroke affecting dorsal midbrain characterised by ipsilateral 3rd nerve palsy with contralateral tremor, ataxia or chorea (red nucleus)

50
Q

Clinical features of 4th nerve palsy?

A

Vertical diplopia
Hypertropia
Depression of eye is limited
Compensatory head tily

51
Q

Causes of 4th nerve palsy?

A

Congenital

Trauma

52
Q

Clinical features of 6th nerve palsy

A

Horizontal double vision
Esotropia in primary position
Abduction limited

53
Q

Causes of 6th nerve palsy?

A

Diabetes and hypertx

Increased ICP; abducens passes over petrous tip and so can easily be squashed by increased pressure

54
Q

What is the pathology of myasthenia gravis?

A

Autoimmune disease of ACh receptors at post-synaptic NMJ

55
Q

Clinical features of myasthenia gravis

A 
Ptosis; bilateral
Cogan lid twitch 
Diplopia
Ophthalmoplegia
Fragility and weakness or muscles of facial expression and proximal limb muscles
56
Q

Ix for myasthenia gravis

A

Ice test; ptosis imrpvoes
Antibodies; anti-ACh receptor antibody and MUSK antibody
EMG and muscle biopsy
Imagine of thorax for thymoma

57
Q

Mx for myasthenia gravis?

A

Pyridostigmine
Steroids
Immunomodulators
Surgery if thymoma present

58
Q

Features of myotonic dystrophy

A

Delayed muscular relaxation and muscle wasting
Early onset cataract
Ptosis
Hypermetropia

59
Q

What causes myotonic dystrophy?

A

AD

Trinucleotide repeat on chromosome 19

60
Q

Cause of NF1

A

AD

Mutation in NF1 gene on chromosome 17

61
Q

Clinical features of NF1

A

Neurofibromas
Cafe-au-lait spots
Axillary freckling
Ophthalmic features; optic nerve glioma, bilateral lisch nodules, plexiform neurofibromas of eyelid

62
Q

Cause of NF2

A

Mutation in NF2 gene on chromosome 22

63
Q

Features of NF2

A

Cataracts

Bilateral vestibular schwannoma

64
Q

What is benign essential blepharospasm?

A

Bilateral idiopathic condition characterized by involuntary contraction of orbicularis oris muscle
Presents in 6th decade
Diagnosis of exclusion

65
Q

Tx for benign essential blepharospasm

A

Artificial tears

Botulinum toxin injection

66
Q

What is contained within the cavernous sinus?

A

ICA and CN6 pass directly through

Lateral walls; CN 3,4 and 5 (V1 and V2)

67
Q

Clinical features of cavernous sinus syndrome?

A

Ptosis and ophthalmoplegia: compression of CN 3,4,6
Loss of corneal reflex: CN V1
Maxillary sensory loss
Horner’s syndrome; internal carotid ocular sympathetics
Proptosis and periorbital swelling

68
Q

What can cause cavernous sinus syndrome?

A 
Infections
Tumours
Cavernous sinus thrombosis
Internal carotid aneurysm
Carotid-cavernous fistula

Neurology (48 decks)

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