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OPTIC NERVE ANOMALIES > ONH - NERVE EDEMA > Flashcards

ONH - NERVE EDEMA Flashcards

1
Q

what is papilledema?

A
  • bilateral swollen optic nerves 2/2 increased intracranial pressure (ICP)
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2
Q

what are causes of ICP?

A
  1. intracranial mass
  2. IIH
  3. inhibition of the arachnoid villi from absorbing cerebral spinal fluid
  4. malignant HTN
  5. venous sinus thrombosis
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3
Q

what happens to axon flow if the ICP increases too much?

A

axoplasmic flow from optic nerve is halted or reversed. This backflow causes bilateral swollen optic nerves

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4
Q

why is papilledema bilateral?

A

b/c ICP occurs posterior to the optic chiasm

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5
Q

what are symptoms of papilledema?

A
  1. Blurry vision
  2. Headache
  3. Nausea
  4. Color vision abnormalities
  5. Transient vision disturbance
  6. Dimming of vision
  7. APD
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6
Q

signs of papilledema?

A
  1. bilateral swollen ONH
  2. abnormal red saturation test
  3. VF defect – enlarged blind spot
  4. Patron’s lines – retinal folds due to stretching over the edema
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7
Q

tx for papilledema?

A
  • Measure BP – r/o malignant HTN
  • Order FAF – r/o pseudopapilledema (ONH drusen)
  • Order MRI/CT scan to r/o mass – always suspect intracranial mass
  • Order lumbar puncture if MRI/CT scans are clean – checks CSF prssure
  • Order CBC, fasting blood sugar, ESR, CRP, ANA, ACE – find out etiology
  • Refer to neurology to tx underlying etiology
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8
Q

what is IIH?

A

it is papilledema with no apperant cause

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9
Q

who is most likely to get IIH?

A

FAT, FERTILE, FEMALE

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10
Q

what are some drugs associated with IIH?

A

pneumonic: VaN CATS
1. Vitamin A
2. Nalidixic acid
3. Contraceptives
4. Accutane
5. Tetracyclines
6. Synthroid

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11
Q

symptoms of IIH?

A

same as papilledma:
1. Blurry vision
2. Headache
3. Nausea
4. Color vision abnormalities
5. Transient vision disturbance
6. Dimming of vision
7. APD

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12
Q

In order to be classified as IIH, what 3 criteria must be met?

A
  1. papilledema (due to increased ICP)
  2. normal brain MRI/CT
  3. high cerebral spinal fluid pressure on lumbar puncture (>200 mmH2O in non-obese & >250 mmH2O in obese patients)
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13
Q

tx for IIH?

A

tx is aimed to eliminate possible cause factors:
* d/c known associated medication
* obese patients should lose weight
* oral acetazolamide should be used to reduce the production of cerebral spinal fluid at the choroid plexus
* f/u every 3 weeks to 3 months depending on severity & respond to tx.

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14
Q

what is nonarteritic ischemic optic neuropathy (NAION) & arteritic ischemic optic neuropathy (AION)?

A

Both unilateral disc edema due to ischemia from blockage of the posterior ciliary artery.

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15
Q

Which dz NAION or AION is an emergency? what is the pneumonic to remember it by?

A

Arteric is Alarming
NonArteritic is Not Alarming

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16
Q

what is NAION caused by?

A

Caused by cardiovascular disorders:
* HTN
* DM
* hypercholesterolemia
* smoking

Caused by drugs (VISA):
* Amiodarone
* Imitrex
* Vardenafil
* sildenafil

17
Q

what is AION caused by?

A

AION is caused by GCA which is characterized by inflammation of both medium and large size arteries.

18
Q

why is it important to tx AION quickly?

A

patient may lose vision in the fellow eye within 24 hours

19
Q

what are symptoms of both NAION & AION?

A
  • sudden, unilateral, painless vision loss
20
Q

what specific symptoms of AION?

A
  • amaurosis fugax
  • HA
  • Malaise
  • fever
  • scalp tenderness over ipsilateral temporal artery
  • jaw claudication
  • weight 2/2 jaw claudication
21
Q

what are signs of both NAION & AION ?

A
  • unilateral swollen ONH
  • APD
  • VF defects
  • small optic cup (disc at risk)
22
Q

what is the most common VF defect for AION?

A

Inferior altitudinal

23
Q

what is the a specific finding for NAION?

A

long term optic nerve pallor

24
Q

tx/managment for AION/NAION?

A
  • immediately start IV steroids for inflammation
  • STAT CRP & ESR should be ordered
  • temporal biopsy should also be ordered – may be false negative due to skip lesions
  • If testing r/o AION – then pts should d/c steroids & start taking aspirin as prophylaxis.
25
Q

what indicates abnormal ESR?

A
  • men = age/2
  • femal = age + 10/2
26
Q

what is optic neuritis?

A

inflammation of the optic nerve

27
Q

what systemic dz is optic neuritis associated with?

A

Multiple sclerosis (MS)

28
Q

symptoms of optic neuritis?

A
  • unilateral sudden loss of vision – due to swelling of the ONH
  • pain on eye movment – swelling compresses EOMs
29
Q

signs of optic neuritis?

A
  • unilateral swollen ONH w/ APD
  • unilateral color vision defects
  • variable VF defects
  • May need an MRI of the brain and orbit to r/o retrobulbar optic neuritis (inflammation behind the globe)
30
Q

tx for optic neuritis?

A
  • refer to neurology for MRI to investigate for MS
  • IV steroids then transition to oral steroids
  • f/u every 1-6 months depending on the severity and response of tx

OPTIC NERVE ANOMALIES (6 decks)

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