Neurophthalmology

Question 1

C/F

1) papilloedema
2) Pseudotumor cerebri
3) Optic neuritis
4) Tobacco Amblyopia
5) A-AION (giant cell arteritis)
6) NA-AION ( HTN, severe blood loss)
7) Hereditary/Lebers Optic neuropathy

Answer 1

1)( vision/colour vision/ pupil rxn) normal
amaurosis fugax
enlargement of physiological blind spot

2) as papilloedema+ dull boring headache+
U/L or B/L CN VI palsy

3) U/L ( dec vision/AbN color vision/AbN pupil
rxn ie RAPD/Marcus Gunn pupil)
+ PainFUL eyeball movement
+ Central Scotoma
+ UHTHOFF phenomenon (inc with temp)

4) Centrocecal scotoma

5) Sudden onset painFUL loss of vision
+/- jaw claudication, temporal headache

6) Sudden painLESS loss of vision at EARLY MORNING
7) sudden painLESS, loss of vision of one eye rapidly affecting other eye+ pupil rxn Normal

Question 2

Fundus and other investigation

1) Papilloedema
2) Pseudotumor cerebri
3) Optic neuritis
4) Toxic Amblyopia
5) A-AION
6) NA-AION
7) Hereditary Lebers Optic neuropathy

Answer 2

1) optic nerve head edema ( starts from nasal side) + cup obliteration +superficial HGE + peripapillary retinal edema

2) B/L Papilloedema+ Increased ICP
but CSF composition and CT scan Normal

3) blurred optic disc margin + 
optic disc hyperemia
Edema less than that of papilloedema 
superficial hemorrhages (Few)+
PULFRICH phenomenon ( impaired depth perception)

4) Crowding phenomenon
5) Optic nerve hyperemia
6) pale edematous optic nerve
7) Telengiectatic vessels at optic disc

Question 3

Most common patient profile of pseudotumor cerebri

Answer 3

Middle aged female fat/obese on OCP

tetracycline intoxication

Question 4

Parts of optic nerve

which is the smallest part

which is the longest part

which part has sinus course

Answer 4

Intraocular
intraorbital
intracanalicular
intracranial

Intraocular

Intraorbital

Intraorbital

Question 5

Location of lesion in

1) Argyll Robertson Pupil
2) Homes Adie Pupil
3) Hutchinson pupil
4) Horner syndrome
5) Wernicke’s hemianomic pupil
6) Marcus Gunn pupil

Answer 5

1) Internuncial neurons btw Pretectal neurons and Edinger Westphal nucleus
2) Postganglionic fibres to Sphincter pupillae
3) Head trauma
4) superior cervical sympathetic ganglion/ other sympathetic nerves
5) Optic tract lesion
6) Optic nerve/ Severe retinal disease

Question 6

Light reflex fibres pass through which nerve

Answer 6

Inferior division of oculomotor nerve

Via nerve to inferior oblique

Question 7

Causes of nystagmus

1) Optokinetic , absent in which region
2) ataxic
3) See Saw
4) rotational
5) downbeat

Answer 7

1) physiological, absent in parietal lobe lesion
2) inTERnuclear ophthalmoplegia
3) bitemporal hemianopia (chiasmal leaion)
4) miner’s
5) Multiple sclerosis, Alcoholic, Arnold Chiari

Question 8

Site of lesion in

inTERnuclear ophthalmoplegia

One and half syndrome

8 and half syndrome

Answer 8

Medial longitudinal fasciculus

Pontine parareticular fibres

Pontine parareticular fibres + CN VII

Question 9

Centre for vertical gaze

centre for horizontal gaze

Answer 9

Interstitial nucleus of cajal

Pontinr parareticular fibres (PPRF)

Question 10

Eye muscles and squint not discussed

Answer 10

Please see from notes