Neurology of Eye Disease

Question 1

What feature of neuro-ophthalmic disease is present if a patient has double vision?

Answer 1

Eye movement defect

Question 2

How is the cause of a neuro-opthalmic defect identified?

Answer 2

Full medical and neurological examination
Bloods
MRI
Lumbar Puncture if suspected MS

Question 3

What can potentially cause an eye movement defect?

Answer 3

IIIrd Nerve
IVth Nerve
VIth Nerve
Inter-nuclear (in nucleus of the cranial nerve)
Supra-nuclear (in the frontal lobe, signal is broken before reaching nucleus)

Question 4

A palsy of CN VI removes the ability to move the eye in which direction?

Answer 4

Laterally (temporally)

Due to Lateral Rectus dysfunction

Question 5

What other pathologies would cause the lateral rectus to malfunction?

Answer 5

Myositis
Impingement (due to petrous tip of temporal bone which CN VI passes over)

Question 6

What sign is often seen on fundoscopy if there is a CN VI palsy?

Answer 6

Papilloedema

Question 7

What movements is the superior oblique responsible for?

Answer 7

Down and IN

adduction

Question 8

If there is a IV nerve palsy, how does the eye normally appear to sit?

Answer 8

Eye cant move down in adduction

=> sits a bit higher than usual when looking straight ahead

Question 9

How do patients compensate the work of CN IV?

Answer 9

They tilt their head to move their eye inwards for them

Question 10

What can cause a IV nerve palsy

Answer 10

Congenital decompensated
Microvascular
Tumour
Bilateral – closed head trauma

Question 11

What causes a palsy of CN VI?

Answer 11

Microvascular
Raised Intracranial pressure
Tumour
Congenital

Question 12

Name all the eye muscles that are supplied by CN III

Answer 12

Medial rectus muscle
Inferior rectus 
Superior rectus
Inferior oblique
Sphincter pupillae
Levator palpebrae superioris

Question 13

How does the eye appear if the CN III is paralysed

Answer 13

Down and OUT

Question 14

What are the main causes of a CN III palsy

Answer 14

Microvascular
Tumour
Aneurysm
MS
Congenital

Question 15

Why is CN IV most susceptible to compromise on head trauma?

Answer 15

Longest CN with a course from the posterior brain to anterior eye

Question 16

An aneurysm of what artery can cause impingement of CN III?

Answer 16

Posterior communicating artery

Question 17

If the pupil is spared in a suspected CN III palsy, what is thought to be the cause?

Answer 17

Microvascular cause

Question 18

What has occurred if pupil involvement is seen in a CN III palsy?

Answer 18

Superficial periphery of optic nerve = damaged by aneurysm

Question 19

What is meant by the term Inter-nuclear Ophthalmoplegia?

Answer 19

Both eyes need to move in the same direction at the same time and speed

Question 20

What can cause Inter-nuclear Ophthalmoplegia?

Answer 20

Multiple sclerosis
Vascular
Lots of small print

Question 21

Plaques on an MRI is a sign of what disease process?

Answer 21

Demyelination in Multiple Sclerosis (MS)

Question 22

What can cause visual field defects?

Answer 22

Vascular disease
Space occupying lesion
Demyelination (MS)
Trauma - including surgical

Question 23

How does optic neuritis usually present?

Answer 23

Progressive visual loss (unilateral)
Pain behind eye, especially on movement
Colour desaturation
Central scotoma
Gradual recovery over weeks - months

Question 24

Patients with what other condition usually develop optic neuritis?

Answer 24

MS

Question 25

What tumours are known to cause problems within the optic nerve?

Answer 25

Meningioma
Glioma
Haemangioma

Question 26

What tumours can present at the optic chiasm?

Answer 26

Pituitary tumour
Craniopharyngioma
Meningioma

Question 27

In the context of pituitary tumours, visual loss or disturbance is commonly reversed after the tumour is decompressed or removed. TRUE/FALSE?

Answer 27

TRUE

Question 28

What does a horizontal field loss indicate?

Answer 28

A problem within the eye itself or the optic nerve head

NOT within the brain

Question 29

What can cause visual disturbance from the occiptal cortex

Answer 29

Vascular disease (CVA)
Demyelination

Question 30

What part of the eye is spared if the lesion disturbing vision is in the occiptal cortex?

Answer 30

macula

Question 31

What lesions can cause vision disturbance from the optic tracts and radiations?

Answer 31

Tumours (primary or secondary)
Demyelination
Vascular anomalies

Question 32

What does the visual field defect look like if there is a lesion present in the optic tract/radiations?

Answer 32

Homonomous defects (temporal on one eye and nasal on one eye => both same visual field)
Macula not spared
Quadrantanopia
Incongruous