Neuroscience Flashcards
Elevated ESR
Men >age/10 Women > Age +10/2.
Elevated CPR
> 2.45 mg/dL
Elevated platelets
> 400,000
what can cause AAION
Giant cell arterities, polyarteritis nodosa, LPE, HZ.
Who is at risk for NAION
Disk at risk. Small disc and Cup. HTN, Hyperchol, DM. Nocturnal hypotension. Sleep apnea and viagra. non-progressive. >50. Vision rarely improves.
Lab tests to NAION
ESR and CRP will be normal.
Diabetic Papillopathy
ON edema. Young patients with DM type I or old patients with DM II. Reversible ischemia from unknown cause. Rarely present with vision loss but instead blurred or distorted vision. Normally have diabetic retinopathy too. Also commonly has disc at risk.
Elderly can hand _____ eye pressure
lower. Due to rigid sclera.
what patients could have hypotony
trabeculectomy, wound leak, cyclodialysis cleft, iridiocyclitis, CB detachment, rhegmatous RD, ocular hypo perfusion.
Signs of hypotony
folds in desemets, corneal edema, a shallow anterior chamber, cataract formation, hyptony maculopahty, chorioretinal folds, and Optic disc edema.
Optic disc drusen
hyaline bodies within the OD. Can be hereditary (AD). Hyper reflective on a B scan. Extensive OD druse can compress retinal ganglion cell fibers in the ON and cause VF defects that mimic glaucoma. Can cause pseudo disc edema or true disc edema due to compression of retinal nerve fibers and axoplasmic flow.
Non-infectious diseases that can cause papilledema
Sarcoidosis, lupus, other collagen vascular dz
Neuroretinitis
anterior Optic neuritis. Optic disc edema and macula edema with hard exudates in a star pattern (macular star). Due to leakage of the superficial vasculature of the OD. Cat scratch fever associated.
Hard Exudates
Loked in OPL. Due to edema resolving and lipids left behind.
Cotton Wool spots
NFL. Due to ischemia of NFL; AKA Soft exudates.
Optic Neuritis
Young patients. F>M, Demyelinating ON associated with MS.
Optic Neuritis
Sudden onset, unilateral vision loss, pain on eye movement, APD, decreased contrast, decreased color vision, VF defect. VA will return to normal in 2-3 months.
Papillitis
Anterior optic nerve and will have disc edema. Only 1/3 cases.
Uthoff’s phenomena
Worse Va with working out. Suggests MS.
Lhermitte’s phenomenon
sensation of electricity traveling down back and into the limbs with flexure of the neck. Occurs in MS.
Internuclear opthamoplegia
Lack of adduction on the affected side. Occurs with MS.
Bilateral INO
Also suggestive of MS. No adduction but convergence can occur. (usually)
Graves
Can cause edema of the optic nerve by compression.
What is spared in graves?
Tendons.
Optic Nerve sheath meningioma
A benign tumor that arises from the optic nerve sheath. Affects young to middle aged woman. Can cause optic nerve edema.
Optic nerve glioma
Most common intrinsic tumor of the ON. Can cause ON edema
Orbital cavernous hemangioma
Most common benign orbital neoplasm in adults. Can cause ON edema by compression. Most common in muscle cone posterior to globe. Fibrous tissue and vessels.
Melanocytoma
Darkly pigmented neoplasm adjacent to or on the ONH. Most common in African Americans and has no effect in vision loss or ON edema.
Papilledema
Bilateral disc edema due to increased ICP. Elevated pressure in the subarachnoid space causes axoplasmic stasis.
Signs of papilledema
opaque retinalNFL. Patrons folds (circumferential retinal folds) hyperemia of the OD, CWS, exudates, splinter hemorrhages, and an absent SVP.
VA early in papilledema
Normal with an enlarge blind spot.
How to tell papilledema apart from bilateral disc edema
Papilledema will have normal VA. bilateral disc edema will not.
Malignant HTN
> 200 mm HG systolic and >12 mm HG diastolic. Cerebrospinal fluid cannot drain into the venous system. Hospitalized due to high stroke risk
Idiopathic Intracranial Hypertension
Overweight females of child bearing age. Increase in ICP with unknown cause.
Classifications for IIH
Must be awake and alert with no other neurological problems (expect CN VI). An elevated CSF >200 or >250 in obese.
Drugs that cause IIH
CANT. Contraceptive, Acutane and vitamins A, Naladixic acid, Tetracycline.
Signs of IIH
Enlarged blind spot, diplopia due to CN 6 palsy, and pailledema.
Infectious causes of bilateral ON edema
TB, Syphyllis, Menegits
Non infectious cause of bilateral ON
Lupus, collagen vascular disease
Toxic/Nutritional Optic atrophy
From B1 or B12 deficiency due to alcoholism or malnutrition. Will have temporal pallor of ON. Patient will have bilateral, painless vision loss and a central or centralcececal VF defect due to damage to papillomacular bundle on temporal side.
Orthograde
The cells die and then the axons. i.e. pop RP, etc
Retrograde degeneration
Damage to tract kills the cells. i.e. damage to retrobulbar optic nerve may result in degernation of the ON axons with the ONH. I.e. pituitary tumor.
Pituitary tumor and ON
Causes a horizontal band of pallor across the ON (bow tie atrophy). Can cause bitemporal hemianopsia or junctional scotoma (temporal loss in one eye and central of diffuse loss in the other)
Leber’s Optic Neuropathy
Mito X linked. Present with sudden decrease in vision. Optic disc hyperemia that then turns to pallor.
Dominant Optic Atrophy
Most common hereditary optic atrophy. Insidious onset of mild to moderate vision loss. Temporal pallor and excavation.
Foster Kennedy Syndrome
A rare condition caused by a frontal lobe tumor. Have optic disc edema in one eye with optic disc atrophy in the other eye.
Optic nerve pit
unilateral depression of the optic dic. Normally IT. May develop a serous retinal detachment that extends from optic nerve to macula.
Morning glory syndrome
Unilateral condition. Enlarged, funnel-shaped, excavated optic nerve with resulting poor VA.
Optic nerve hypoplasia
Incomplete development of the ON. Has a hypo plastic disc surrounding by a ring of sclera and a ring of hyper pigmentation with mild to severe vision loss.
Optic nerve coloboma
Large, abnormally shaped optic disc due to incomplete closure of the fetal issue. Normally IN.
Causes of an APD
Dense virtual hemorrhage, extensive retinal damage, optic nerve damage, optic chiasm damage that involves the adjacent optic nerve.
Reverse APD
Shine light in good eye and it constricts. Shine back to the bad eye and it will dilate if it is positive. Do with fixed, unreactive pupil.
APD
A= good eye dilate when light shined in it. Bad eye will constrict with consensual. Both dilate with direct.
EPD
The bad eye has no direct or consensual. Good eye will always constrict.
APD and EPD
Bad eye will not constrict and good eye will dilate with shinning light in direct.
Will afferent problem every cause anisocoria
NO. Only Efferent. Consensual will help out so no anisocoria.
Physiological anisocoria
Size is the same in light and dark.
What could cause worse anisocoria in dark. i.e. miotic pupil is bad one
Horners, argyll robertson, uveitis with posterior synechiae.
If the anisocoria is worse in light i.e. mydriatic eye
CN 3 palsy, Adies tonic pupil, iris sphincter trauma, dilation with meds.
Internal opthalmoplegia
paralysis of pupils.
Horners syndrome causes
Pan coast tumor (pre), carotid dissection, internal carotid artery aneurysm.
Argyll Robertson
Affects all fibers entering the EW on one side. Causes efferent problem but normal Near light dissociation. The eye is worse in dark. Mitosis.
CN III Pupil
Compressive lesion of CN III. Fixed and dilated and unresponsive to light or accommodation. 1% pilocarpine will constrict the pupil of the affected eye. Efferent problem.
Adies Tonic Pupil
Fixed dilated eye. Lesion in ciliary ganglion. Efferent. Vermiform movement of the iris. May have diminished deep tendon reflexes. Prolonged and slow near response. Loss of accommodation too.
Testing for Adies
0.125% pilocarpine will cause construction of the affected eye.
Iris sphincter trauma
Worse in light. Vermiform movement. iris atrophy. Notching of the iris pupillary margin.
How to differentiate a pharm dilated pupil
Will not constrict in response to pilocarpine.
Hutchinson’s pupil
Dilated pupil in comatose patients. Result of an ipsilateral tumor or subdural hematoma compressing the superficial pupillary fibers of CN 3
Mitosis in coma
Early stage of coma induce mitosis due to loss of inhibitory cortical input to the EW nucleus.
What causes AR
neurosyphilis.
Most common cause of CN III palsy compression
PCA aneurysm
Most common cause of CN III Palsy
Microvascular due to DM or HTN
What will CN III look like
Down and out eye with ptosis.
Aberrant regeneration in CN III
Only with compressive. Get imaging.
Which nerve is most susceptible to trauma
CN IV as it has longest path.
Acquires vs. congenital CN IV palsy
Congenital have large vertical verrgence ranges. Acquires have normal ranges.
Which way will someone with a SO palsy tilt
Away
SOURS
SO-Unaffected side. SR-same side.
Which EOM palsy is most common overall
CN VI
What do 10% of patients with MG have?
A thymoma. Get a chest Xray
MG epidemiology
presents in younger women and older males
Cogan’s lid twitch
Look down for 15 seconds then look up. Will have an absent ptosis that then twichtes and goes to original position.
