Ophthamology: Neuro-ophthamology

Question 1

What is the first thing to assess in a patient with diplopia?

Answer 1

If it’s monocular or binocular

-binocular is more serious because it indicates a neuro issue.

Question 2

Most common cause of monocular diplopia.

Answer 2

Astigmatism

Question 3

Direction the eye deviates in CN III palsy.

Answer 3

Down and Out

Question 4

Why is a blown pupil more emergent than impaired extraocular muscles in CN III palsies?

Answer 4

Blown pupil usually means an aneuysm compressing the nerve which can lead to a stroke or more severe condition. (occurs at the junction of the posterior communicating artery and internal carotid).

Impaired EOM is usually a diabetic infarct

Question 5

What should you do in a patient with CN III palsy and a blown pupil? Without a blown pupil?

Answer 5

w/: Order and MRI and angiogram

w/o: Check blood sugar and blood pressure

Question 6

Main cause of CN VI palsy.

Answer 6

Increased intracranial pressure that stretches the nerve. It exits the pons and runs along the floor of the skull up towards the cavernous sinus.

Question 7

What is pseudotumor cerebri?

Answer 7

A neurological disorder that is characterized by increased intracranial pressure in the absence of a tumor or other diseases. Can lead to CN VI palsy.

Question 8

How do patient’s present with injury to CN IV?

Answer 8

Head tilt opposite the side of the injured nerve.

Question 9

Common causes of trochlear nerve palsy.

Answer 9

Trauma, ischemia, congenital defect, tumor

Question 10

What is the number one reason that a CN is damaged due to a vascular incident?

Answer 10

Diabetes

Question 11

What condition is associated with:

“diplopia that does not map to a specific cranial nerve”?

Answer 11

Myasthenia Gravis

Question 12

The Tensilon Test is used to diagnose myasthenia gravis and is a dose of Edrophonium (AChase inhibitor). How would you treat an overdose of this indirect cholinergic agonist?

Answer 12

Atropine (cholinergic antagonist)

Question 13

If a patient is diagnosed with myasthenia gravis, what should you also test them for?

Answer 13

Thymoma: check thryoid hormone levels

Question 14

What is a cardinal sign of optic neuritis and what is it associated with?

Answer 14

1. Loss of color vision
2. Usually a demyelinating disease that is associated with increased RISK of Multiple Sclerosis……..only increased RISK

Question 15

How do you treat optic neuritis?

Answer 15

IV steroids

oral steroids might further increase RISK of MS

Question 16

What must be ruled out in patients over 55 with unilateral vision loss?

Answer 16

Giant Cell Ateritis (temporal arteritis)

Question 17

What two symtoms are indicative of Giant Cell Arteritis?

Answer 17

1. Jaw Claudication

2. Scalp Tenderness

Question 18

What is the procedure for treatment if a physician suspects Giant Cell arteritis?

Answer 18

1. Order sed. rate and CRP
2. Temporal Artery Biopsy
3. Start on steroids immediately (even before test results are back)

Question 19

Name and describe the 2 tests used to diagnose Horner Syndrome.

Answer 19

1. Cocaine Test: block NE re-uptake. A Horner Syndrome patient will still show no effect on the bad eye but the normal eye will have mydriasis.

Paradrine Test: done after cocaine test. Inject hydroxyamphetamine, if the pupil doesn’t dilate it’s a lower motor neuron (3rd order) death.
If the pupil dilates, it’s a higher (1st or 2nd order) neuron issue.

Question 20

What should you check for in a patient with Horner Syndrome and pain?

Answer 20

Internal carotid dissection. MRI or angiogram.

Question 21

What is Adie’s Tonic Pupil?

Answer 21

Loss of parasympathetic innervation to the pupil. Pupil is dilated and won’t constrict.