Oculomotor/Visual Flashcards
Argyll-Roberts Pupil
Pupillary Abnormalities
Pathophysiology:
- neurosyphilis
- lesions in Edinger-Westphal nucleus
Clinical:
- small, poorly reactive to light
- light near dissociation (restriction with accommodation) preserved
Dx/Rx:
Horner’s syndrome
Pupillary Abnormalities
Pathophysiology:
-lesion of central of peripheral CN III
Clinical:
- miotic pupils
- mild ptosis
- anhidrosis
Dx/Rx:
Marcus-Gunn pupil
Pupillary Abnormalities
Pathophysiology:
Clinical:
- one pupil constricts less markedly in response to direct illumination than in response to illumination of the contralateral pupil
Dx/Rx:
Oculomotor (III)
Gaze palsies
Pathophysiology:
- ptosis
- lateral deviation
- (+) diplopia in all directions
Intranuclear Ophthalmoplegia
Gaze palsies
Pathophysiology:
- lesion of medial longitudinal fasciculus
- most commonly caused by MS
Clinical:
- inability to gaze toward side of lesion
Dx/Rx:
Trochlear (IV)
Gaze palsies
- involved eye is elevated in primary forward gaze
- worsened with adduction and head tilt toward lesion
Abducens (VI)
Gaze palsies
- adduction at rest
- failure of attempted abduction
One and a half syndrome
Gaze palsies
Pathophysiology:
- MLF + PPRF lesion
- 2/2 pontine infarcts, MS, hemorrhage
Clinical:
- ipsilateral eye immobility
- contralateral eye restricted to abduction
Dx/Rx:
Amaurosis Fugax
Pathophysiology:
- embolic cause?
- increased risk of TIA
Clinical:
-unilateral transient loss of vision that is maximal at onset and resolves over 10-20 minutes
Dx/Rx:
Optic Neuritis
Pathophysiology:
- inflammation of optic nerve
- usually 2/2 demyelination (MS, etc.)
Clinical:
- painful, unilateral visual loss
- +/- unilateral disk swelling
Dx/Rx: IV prednisone
Anterior ischemic optic neuritis?
Pathophysiology:
- occurs >50yo
- assumed to be atherosclerotic in origin
Clinical:
- sudden, painless monocular vision loss
- ipsilateral disk swelling
- symptoms are maximal at onset and often subtotal with altitudinal defect
Dx/Rx:
