Ophthalmology relating to Neurology

Question 1

Anterior ischaemic optic neuropathy occurs due to occlusion of the _______

Answer 1

short posterior ciliary artery

Question 2

Two main causes of anterior ischaemic optic neuropathy?

Answer 2

giant cell arteritis and atherosclerotic event due to hypertension and or diabetes etc

Question 3

Horners syndrome cause a triad of symptoms ________ due to a _______

Answer 3

ptosis, meiosis and anhydrosis

lesion in the sympathetic pathway

Question 4

List some causes of Horner’s syndrome?

Answer 4

stroke, syringomyelia (cyst or cavity in spinal cord), pan coast tumour, carotid aneurysm/ dissection, ICA dissection, cluster headache, cavernous sinus lesion, if children the likely cause is trauma

Question 5

If Horner’s syndrome is painful what cause should you think of?

Answer 5

carotid/ ICA dissection

Question 6

Lateral medullary syndrome is also known as _______

Answer 6

Wallenbergs

Question 7

Lateral medullary syndrome occurs due to _____________

Answer 7

blockage of the posterior inferior cerebellar artery or vertebral artery

Question 8

Clinical features of lateral medullary syndrome?

Answer 8

Damage to the vestibular nucleus causing vertigo,vomiting and nystagmus.
Damage to the descending sympathetic system causing ipsilateral Horner’s syndrome.
Damage to the spinal trigeminal tract causing ipsilateral loss of pain/temperature and loss of corneal reflex.
Damage to the spinothlalamic tract causing contralateral loss of pain/temperature in the trunk and limbs.
Other symptoms include dysphagia and horseness.

Question 9

What is Adies pupil?

Answer 9

loss of postganglionic parasympathetic innervation of the iris sphincter and ciliary muscle causes a larger pupil, more common in females and usually unilateral

Question 10

How can you confirm diagnosis of Adies pupil?

Answer 10

add topical pilocarpine (muscarinic receptor agonist), Adies pupil will constrict but normal pupil will not

Question 11

What is Argyll Robertson pupil?

Answer 11

characterised by bilateral, irregular and small pupils, both pupils do not react to light however they constrict normally on accommodation

Question 12

What are the causes of argyll robertson pupil?

Answer 12

previously most common cause was neurosyphilis nowadays it is diabetes

Question 13

How could you test difference between argyll robertson pupil and adies pupil?

Answer 13

0.1% pilocarpine does not cause constriction of the pupils in argyll robertson but does in Adies pupil

Question 14

What is myotonic dystrophy?

Answer 14

Genetic disorder that affects muscle function, characterised by delayed muscular relaxation and muscle wasting (autosomal dominant)

Question 15

Ocular features of myotonic dystrophy?

Answer 15

early onset cataracts, ptosis, hypermetropia, ophthalmoplegia

Question 16

Ocular features of neurofibromatosis?

Answer 16

Type 1: optic nerve gliomas, bilateral lisch nodules, plexiform neurofibromas of the eyelid
Type 2: cataracts

Question 17

What is benign essential blepharospasm?

Answer 17

idiopathic condition chracterised by involuntary contraction of the orbiculares oculi muscle

Question 18

Treatment of benign essential blepharospasm?

Answer 18

artificial tears given as many patients have dry eyes

botox injections around the eye

Question 19

What is cavernous sinus syndrome?

Answer 19

Syndrome caused by compression of the cranial nerves passing through or lying within the cavernous sinus (includes 3,4,V1 and V2, 6 and the internal carotid artery)

Question 20

Causes of cavernous sinus syndrome?

Answer 20

infections, tumours, cavernous sinus thrombosis, internal carotid aneurysm, carotid- cavernous fistula

Question 21

Features of cavernous sinus syndrome?

Answer 21

ptosis and ophthalmoplegia, (3,4 and 6), loss of corneal reflex (V1), maxillary sensory loss (V2), horners syndrome (involvement of sympathetic), proptosis and periorbital swelling (increased venous pressure in the veins draining the orbit)