Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NBEO Part 2 > Optic Nerve/ Neuro-ophthalmic Pathways/Blood Flow > Flashcards

Optic Nerve/ Neuro-ophthalmic Pathways/Blood Flow Flashcards

1
Q

Classic triad of Horner’s

A

PAM!!! PAM!!!
1. Ptosis (small, affects Muller’s muscle)
2. Anhidrosis (lack of sweat on one side)
3. Miosis (pupil constriction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Argyll Robertson pupil associated with what infectious disease?

A

Late-stage syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Physiological anisocoria

A
  • Anisocoria equal under dim and bright conditions
  • no ptosis
  • confirm stability by referring to previous photos of patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs of pupil involving 3rd nerve palsy

A

Eye is down and out with dilated (blown out) pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Patient presents with diplopia, headache, eye is down and out with a blown out pupil, what is your A&P?

A

A. Pupil involving cranial nerve 3 palsy caused by aneurysm of the posterior communicating artery
P. Send to emergency room ASAP (EMERGENT!!!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Congenital Horner’s syndrome signs

A

Iris heterochromia (affected eye will have lighter iris)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Characteristics of tilted disc syndrome

A
  • Bilateral
  • optic nerve enters at an oblique angle superiorly
  • situs inversus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Signs of tilted disc syndrome

A
  • myopic
  • fundus ectasia
  • superior temporal VF defects that do not respect the midline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A&P for Horner’s

A

A. Horner syndrome
1. isolated damage of 3rd order neuron
2. pre-ganglionic lesion

Plan
1. No further investigation
2. Refer for MRI of head and neck and a CT scan of thorax or chest x-ray (pancoast tumor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Right homonymous hemianopia is associated with stroke on which side of the brain? And can cause hemiparesis on which side of the body?

A

Cerebrovascular accident on left side of brain and patient likely has hemiparesis on right side of their body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pulfrich phenomenon

A

Pendulum is perceived as moving in a circular motion rather than laterally
* symptom of optic neuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ocular manifestation of multiple sclerosis

A

Optic neuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Optic neuritis age demographic

A

18 to 45 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Uhthoff sign

A

Associated with MS

Symptoms worsen with increase in body temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

True or false
Horner’s syndrome can be caused by internal carotid artery dissection

A

TRUE
* 3rd order neuron damage from internal carotid artery dissection can cause Horner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Patients suspected with Horner’s due to a pre-ganglionic lesion should be referred for what further testing?

A
  • MRI of head and neck
  • CT scan of thorax
  • chest x-ray (check for pancoast tumor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Parietal lobe lesion will produce what VF loss?

A

Inferior incongruous or congruous VF loss (quadrantanopia)
* pie on the floor (parents put you down lesion in parietal lobe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lesion in temporal lobe produces what VF loss?

A

Superior quadrant VF defect, incongruous and wedge shaped, can also be complete
* superior quadrantanopia = pie in the sky

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Optic radiations traveling through ____ lobe carry visual information from the superior retina

A

Parietal lobe
* VF loss will be opposite therefore superior retina damage will cause inferior VF loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

3rd order neuron irregularities can be caused by?

A

Cluster headaches
Otitis media
Masses in cavernous sinus
Internal artery dissections
Nasopharyngeal tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pancoast tumor can cause which order neuron irregularity in Horner’s?

A

2nd order neuron lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most common cause of pupil sparing isolated 3rd nerve palsy?

A

Microvascular disease secondary to HTN &/or diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Blood supply to oculomotor nerve

A

Surface and pupillary fibers are supplied by pial blood vessels; internal fibers are supplied by the vasa nervorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the common triggers of a classic migraine?

A
  • stress
  • coffee
  • chocolate
  • cheese
  • prolonged periods without food
  • bright lights
  • alcohol
  • severe fatigue
  • birth control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Visual aura of a classic migraine would produce what type of visual field defect?

A

Homonymous hemianopsia
* start in center and enlarge in homonymous portions of the visual field
* HA located on contralateral side of field defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Leber hereditary optic neuropathy is more common in males or females?

A

males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is Tilted Disc Syndrome?

A

A condition where the optic nerve enters the eye at an oblique angle, causing elevation of superior nerve tissue and ectasia of inferior/infero-nasal tissue

Typically observed bilaterally.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What visual field defects are often associated with Tilted Disc Syndrome?

A

Superotemporal defects

These defects may diminish or disappear with myopic astigmatism correction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are common symptoms of Tilted Disc Syndrome?

A

Majority are asymptomatic; some may report visual field defects or blurred vision

Symptoms can be caused by uncorrected astigmatism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What clinical signs indicate Tilted Disc Syndrome?

A
  • Obliquely inserted disc
  • Myopic astigmatism
  • Tilted optic disc with inferior ectasia
  • Superior elevation of nerve tissue
  • Situs inversus
  • Fundus ectasia
  • Superotemporal visual field defects

Visual field defects generally do not respect the midline.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the treatment for Tilted Disc Syndrome?

A

Visual correction to neutralize the associated refractive component

No additional treatment is required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How often should patients with Tilted Disc Syndrome be evaluated?

A

Annually

Regular follow-up helps monitor any changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Fill in the blank: Tilted Disc Syndrome is caused by an optic nerve that enters the eye _______.

A

[superiorly at an oblique angle]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

VF defects of tilted disc syndrome similar to what type of tumor VF defect?

A

Pituitary gland tumor —> bitemporal field defect
* neuroimaging required to establish concrete diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the primary function of the Circle of Willis in relation to the eyes?

A

The Circle of Willis provides collateral circulation to the brain, including areas that supply blood to the eyes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

True or False: The ophthalmic artery is a branch of the internal carotid artery, which is part of the Circle of Willis.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Fill in the blank: The Circle of Willis is located at the base of the ______.

A

brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Multiple Choice: Which of the following arteries is NOT part of the Circle of Willis? A) Anterior cerebral artery B) Middle cerebral artery C) Posterior tibial artery D) Posterior cerebral artery

A

C) Posterior tibial artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the main arteries supplying blood to the iris and ciliary body?

A

Long posterior ciliary arteries and anterior ciliary arteries

These arteries are branches of the ophthalmic artery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is formed by the terminal branches of the long posterior ciliary arteries and anterior ciliary arteries?

A

The major arterial circle of the iris

This circle lies behind the root of the iris in the ciliary body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Where does the major arterial circle of the iris lie?

A

Behind the root of the iris in the ciliary body

It is formed by anastomoses of the long posterior and anterior ciliary arteries.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the path of blood vessels from the major arterial circle?

A

They course around the circumference of the iris, from the periphery toward the pupil

This arrangement supports blood flow to the iris.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What forms the minor arterial circle of the iris?

A

Centripetal branches of the major arterial circle

Minor circle is incomplete and lies just inside the pupillary border.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the location of the minor arterial circle of the iris?

A

Just inside the pupillary border

It is involved in the initial signs of neovascularization of the iris.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

True or False: The minor arterial circle of the iris is responsible for the complete blood supply to the iris.

A

False

The minor circle is incomplete and primarily indicates neovascularization.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Fill in the blank: The _______ arteries anastomose with the anterior ciliary arteries to form the major arterial circle of the iris.

A

long posterior ciliary

These arteries are crucial for the vascular supply to the iris.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Initial signs of neovascularization of the iris is located where?

A

The minor arterial circle of the iris at the pupillary margin

Initial signs of neovascularization are observed in this area.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is papillophlebitis?

A

A rare condition observed in younger patients, usually under 50 years of age.
* inflammation of the optic disc venous drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the typical health status of patients with papillophlebitis?

A

Generally healthy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the clinical signs of papillophlebitis?

A

Sudden unilateral blurring of vision, disc edema, cotton wool spots, dilation and tortuosity of veins, and retinal hemorrhages restricted to the posterior pole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What age group is most commonly affected by papillophlebitis?

A

Patients under 50 years of age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the prognosis of papillophlebitis without treatment?

A

Typically good, unless chronic macular edema remains.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Fill in the blank: Clinical signs of papillophlebitis include _______.

A
  • sudden unilateral blur
  • disc edema
  • cotton wool spots
  • dilation and tortuosity of veins
  • retinal hemorrhages.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

True or False: Papillophlebitis is more common in older patients.

A

False.
* common in younger pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is aberrant regeneration in the context of cranial nerve palsy?

A

It occurs when third cranial nerve fibers misdirect to alternate muscles innervated by the same nerve.
* does not occur with ischemic 3rd nerve palsies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What muscles does the oculomotor nerve control?

A
  • Medial rectus
  • Superior rectus
  • Inferior rectus
  • Inferior oblique
  • Iris dilator muscle
  • levator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What causes aberrant regeneration of the oculomotor nerve?

A

Damage from trauma or compression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the pseudo-Graefe sign?

A

Elevation of the involved eyelid on downgaze or adduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

List the most common signs of aberrant third nerve regeneration.

A
  • Eyelid-gaze dyskinesis
  • Pupil-gaze dyskinesis
  • Constriction of the pupil on downgaze or adduction
  • Elevation of involved eyelid on downgaze or adduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

True or False: Aberrant regeneration can lead to limitation of elevation or depression of the eye.

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Fill in the blank: Aberrant regeneration may lead to _____ on attempted elevation or depression.

A

adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is a less common sign of aberrant third nerve regeneration?

A

Absent optokinetic nystagmus response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the cavernous sinus?

A

A large collection of thin-walled veins that create a cavity within the human head, bordered by the temporal and sphenoid bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How does the cavernous sinus receive blood?

A

Via the superior and inferior ophthalmic veins and the superficial cortical veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What channels drain the cavernous sinus?

A

The superior and inferior petrosal sinuses and into the jugular vein via the sigmoid sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What major artery runs through each cavernous sinus?

A

The internal carotid artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which cranial nerves are contained within the cavernous sinus?

A
  • Oculomotor nerve (CN III)
  • Trochlear nerve (CN IV)
  • Ophthalmic nerve (V1 branch of CN V)
  • Maxillary nerve (V2 division of CN V)
  • Abducens nerve (CN VI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How do the cranial nerves run within the cavernous sinus?

A

From superior to inferior within the lateral wall of the cavernous sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Where does the abducens nerve (CN VI) run in relation to the cavernous sinus?

A

Through the middle of the sinus alongside the internal carotid artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Which cranial nerves pass through the cavernous sinus and enter the orbital apex via the superior orbital fissure?

A
  • CN III
  • CN IV
  • CN VI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Where does CN V2 exit the cavernous sinus?

A

Through the foramen rotundum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Where is the optic nerve located in relation to the cavernous sinus?

A

Just outside and superior to the cavernous sinus on each side, entering the orbital apex via the optic canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is the typical result of lesions involving the cavernous sinus?

A

Dysfunction of several nerves due to their close proximity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Which CN pass through the cavernous sinus and enter the orbital apex through the superior orbital fissure?

A
  • CN 3
  • CN 4
  • V1 of CN 5
  • CN 6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Pt with pupil involving CN 3 palsy and has medical history of congenital heart defect and has a pace maker should NOT get what type of imaging done?

A

MRI
* pt should get CT and CTA instead to confirm diagnosis of intracranial arterial aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

If neuroimaging is negative for pt with pupil involving third nerve palsy what additional test should be considered next?

A

Lumbar puncture

  • to evaluate possible presence of blood in CSF, an inflammatory reaction, neoplastic infiltration or infection
  • blood in CSF = rupture of posterior communicating artery aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the pupillary pathway responsible for?

A

The light reflex and the near reflex

The pupillary pathway involves several neurons responding to stimuli.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What does sympathetic input cause in the pupillary pathway?

A

Mydriasis

Mydriasis refers to the dilation of the pupil.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What does parasympathetic innervation cause in the pupillary pathway?

A

Pupil miosis

Miosis refers to the constriction of the pupil.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What does the absence of a light reflex typically indicate?

A

Severe unilateral nerve damage

This absence suggests significant issues with the neural pathways.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Which retinal photoreceptors mediate the response to light?

A

Retinal photoreceptors

These receptors conduct signals to the pretectal nucleus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Where do fibers from the nasal retina cross over?

A

In the chiasm

This allows signals to enter the contralateral pretectal nucleus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What happens to fibers from the temporal retina?

A

They do not decussate and send information to the ipsilateral pretectal nucleus

This contributes to the light reflex mechanism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the role of the Edinger-Westphal (EW) nuclei in the pupillary pathway?

A

They receive input from the pretectal nuclei and relay information

This process results in symmetrical pupil constriction when light stimulates one eye.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What occurs after neurons leave the EW nucleus?

A

They synapse onto the ipsilateral ciliary ganglion

This is crucial for innervating the pupil sphincter.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the effect of damage to the parasympathetic pathway?

A

Mydriasis of the pupil

Damage affects pupil constriction capabilities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Where does the first order neuron of the sympathetic pathway originate?

A

In the hypothalamus

This neuron travels down the spine to synapse onto the ciliospinal center of Budge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the pathway of the second order neuron in the sympathetic pathway?

A

Projects from the ciliospinal center of Budge upwards to the superior cervical ganglion

This ganglion is located in the neck.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What does the third order neuron do in the sympathetic pathway?

A

Sends projections from the superior cervical ganglion along the internal carotid artery

This neuron ultimately reaches the ciliary body and dilator muscle of the pupil.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are the effects of damage to the sympathetic division of the pupillary pathway?

A

Pupillary miosis, ptosis of the upper lid, and elevation of the lower lid

Both Mueller’s muscle and lower lid retractors are innervated by the sympathetic system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the chance of developing maculopathy in patients with non-central optic pits?

A

Up to 45%

This statistic highlights the significant risk associated with non-central optic pits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What are the suggested origins of the subretinal fluid in optic pits?

A

Subarachnoid space or vitreous

Research indicates that the fluid causing issues in optic pits likely originates from these two areas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What has been observed in eyes that have suffered a retinal detachment associated with optic pits?

A

A small opening in the membrane covering the pit

This observation may indicate a pathway for fluid accumulation and retinal issues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What factor might contribute to the formation of a retinal detachment in cases of optic pits?

A

Intravitreal traction on the pit by an atypical Cloquet’s canal

This traction can lead to complications such as detachment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Which types of optic pits are more at risk for developing detachments?

A

Temporal pits and larger pits

The location and size of the optic pit play a critical role in the risk of detachment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Is there an agreed upon method of treatment for patients with optic pits?

A

No agreed upon method exists

Treatment approaches vary, indicating a lack of consensus in the medical community.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What treatment may be warranted if visual acuity is reduced in patients with optic pits?

A

Laser treatment applied to the peripapillary area

This treatment aims to re-establish the connection between the RPE and retina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is the success rate of laser treatment for optic pits?

A

Roughly 30%

This low success rate indicates the challenges in treating conditions associated with optic pits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What are alternative treatment options for optic pits aside from laser treatment?

A
  • Pars-plana vitrectomy
  • Injection of a gas tamponade without vitrectomy

These options can be considered depending on the specific case.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Can serous detachment associated with optic pits resolve spontaneously?

A

Yes, rarely

Spontaneous resolution is uncommon but possible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the prognosis for maculopathy associated with optic pits?

A

Poor prognosis

The associated risks and complications lead to a generally unfavorable outlook.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What should patients be given to monitor for changes related to optic pits?

A

An Amsler grid

This tool helps patients detect visual changes promptly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What percentage of cases may also develop macular holes?

A

Up to 25%

This statistic further emphasizes the complications related to optic pits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

RTC for optic pit

A

Annually but should be given amsler grid because risk of serous macular detachment
Pt educated to RTC ASAP if any changes on amsler

105
Q

Foster-Kennedy syndrome

A
  • Optic disc edema in one eye (papilledema on contralateral side of lesion)
  • optic atrophy in other eye (ipsilateral to side of lesion) will have central scotoma
  • caused by frontal lobe tumor and olfactory groove meningiomas (pt complain of decreased sense of smell)
106
Q

What is the correct sequence for the circulation of cerebrospinal fluid (CSF) in the brain?

A

Lateral ventricle → interventricular foramen → third ventricle → cerebral aqueduct → fourth ventricle → subarachnoid space

107
Q

What is the most commonly affected cranial nerve in cases of elevated intracranial pressure?

A

Abducens (6th cranial nerve)

This is often due to space-occupying intracranial tumors.

108
Q

What are the initial manifestations of tumors in around 50% of patients with an abducens nerve palsy?

A

Headaches and/or diplopia

These symptoms can indicate the presence of a tumor affecting the abducens nerve.

109
Q

What causes an abducens nerve palsy?

A

Increase in intracranial pressure leading to stretching and compression of the 6th cranial nerve

This typically occurs as the nerve courses over the bony petrous tip of the skull.

110
Q

What percentage of patients with an abducens nerve palsy experience headaches and/or diplopia?

A

Around 50%

This statistic highlights the commonality of these symptoms in relation to tumors.

111
Q

RTC for optic nerve melanocytoma

A

Monitor with fundus photography every 6 months
* progressive growth, loss of visual acuity, VF loss, or APD suggests malignant transformation (in that case enucleation may be best treatment)

112
Q

What are optic disc drusen composed of?

A

Hyaline-like calcific material
* best visible with B-scan

113
Q

Oral corticosteroids can help with signs and symptoms of Bell’s palsy if initiated within ___ hours of onset

A

72 hours
* acute phase of bell’s, inflammation and edema of facial nerve are causing facial muscle weakness, anti-inflammatory minimizes nerve damage

114
Q

Pt presents with acute peripheral facial nerve palsy + vesicular eruptions on ear, tongue, face or neck

A

Ramsay-hunt syndrome
* + viral prodrome and severe ear pain
* vestibulocochlear dysfunction, nausea, vomiting, tinnitus, and hearing loss

115
Q

Argyll-Robertson pupils

A
  • Small irregular shape pupils
  • light-near dissociation
  • dilate poorly in darkness
  • bilateral, asymmetrical
116
Q

Parinaud syndrome s/s

A
  • bilateral mid-dilated pupils
  • react poorly to light
  • normal constriction at near
  • eyelid refraction
  • supra-nuclear upgaze paralysis
  • convergence retraction nystagmus
117
Q

Pt sus for Adie’s tonic pupil, what pharmacological agent confirms diagnosis?

A

0.125% pilocarpine
* diluted pilocarpine would constrict abnormal pupil with minimal constriction in normal pupil

118
Q

Pathophysiology of Adie’s tonic pupil

A

Damage to postganglionic nerve fibers of the iris sphincter and ciliary muscle

119
Q

What is the cause of an Adie tonic pupil?

A

Damage to the ciliary ganglion

This damage results in dysfunction of the postganglionic nerve fibers to the iris sphincter and ciliary muscle.

120
Q

What is the typical pupil appearance in Adie tonic pupil?

A

Large pupil on the affected side

This occurs due to the initial insult to the ciliary ganglion.

121
Q

What are common associations with Adie pupil?

A
  • Orbital trauma
  • Surgery
  • Viral infections
  • Chronic tonsillitis
  • Sinusitis
  • Upper respiratory infections
  • Dental anesthesia and tooth extractions

While many cases are idiopathic, some patients can link their Adie pupil to these factors.

122
Q

What causes Argyll-Robertson pupils?

A

Spirochete syphilis

This infection damages the intercalated neurons between the pretectal and Edinger-Westphal nuclei.

123
Q

What type of anisocoria is caused by Horner syndrome?

A

Anisocoria due to a paresis or palsy

This paresis or palsy is located in the oculosympathetic pathway.

124
Q

Damage to intercalated neurons between the pretectal and E-W nuclei in Argyll Robertson pupil is caused by what organism?

A

Spirochete syphilis

125
Q

What is Bell’s palsy characterized by?

A

Acute onset of unilateral weakness of the upper and lower muscles of the face with no apparent cause

126
Q

What should be considered before diagnosing Bell’s palsy?

A

Other causes of acquired peripheral facial weakness

127
Q

List some associated conditions with Bell’s palsy.

A
  • Diabetes
  • Hypertension
  • HIV
  • Lyme disease
  • Ramsay-Hunt syndrome
  • Sarcoidosis
  • Sjogren syndrome
  • Parotid-nerve tumors
  • Temporal bone fracture
  • Guillain-Barre syndrome
128
Q

What type of mass can cause peripheral facial weakness?

A

Cerebellopontine angle mass (e.g., acoustic neuroma, facial neuroma, meningioma, cholesteatoma)

129
Q

How is Bell’s palsy classified in terms of diagnosis?

A

Diagnosis of exclusion

130
Q

What symptoms may patients with Bell’s palsy experience?

A
  • Viral prodrome
  • Ear pain
  • Decreased tearing
  • Decreased taste
  • Facial numbness
131
Q

What is the typical progression time for facial palsy in Bell’s palsy?

A

Usually progresses over a period of 10 days

132
Q

Is Bell’s palsy life-threatening?

A

No, it is non life-threatening

133
Q

What is the incidence of Bell’s palsy?

A

20-30 cases per 100,000 people per year

134
Q

What percentage of unilateral facial paralysis does Bell’s palsy account for?

A

60-75%

135
Q

At what median age does Bell’s palsy typically onset?

A

40 years

136
Q

Which age group has the highest incidence of Bell’s palsy?

A

People older than 70

137
Q

Does Bell’s palsy affect both sexes equally?

A

Yes

138
Q

Do most patients with Bell’s palsy recover completely?

A

Yes

139
Q

True or False: Bell’s palsy rarely recurs.

A

True

140
Q

Fill in the blank: Facial paralysis due to an upper motor neuron lesion will cause weakness of the _______.

A

lower facial musculature only

141
Q

Fill in the blank: Bell’s palsy is due to a _______ lesion.

A

lower motor neuron (peripheral)

142
Q

How often do both sides of the face get affected in Bell’s palsy?

A

With equal frequency

143
Q

What is the significance of determining whether facial weakness is due to an upper or lower motor neuron lesion?

A

It helps to determine the etiology of the disorder.

144
Q

What muscles are spared in an upper motor neuron lesion?

A

Frontalis muscle.

145
Q

In upper motor neuron lesions, what facial feature is preserved?

A

Normal furrowing of the brow.

146
Q

Are eye closure and blinking affected in upper motor neuron lesions?

A

No.

147
Q

What are common causes of upper motor neuron lesions?

A

Space occupying lesions or cerebrovascular accidents.

148
Q

How does an upper motor neuron lesion affect facial innervation?

A

Innervation of the contralateral upper and lower face, and ipsilateral upper face.

149
Q

What part of the face is usually affected by an upper motor neuron lesion?

A

Contralateral lower face.

150
Q

What characterizes lower motor neuron lesions?

A

Weakness of all muscles of facial expression.

151
Q

What happens to the angle of the mouth in lower motor neuron lesions?

A

It falls.

152
Q

Is weakness of the frontalis muscle present in lower motor neuron lesions?

A

Yes.

153
Q

How is eye closure affected in lower motor neuron lesions?

A

Eye closure is weak.

154
Q

What condition is commonly associated with lower motor neuron lesions?

A

Bell’s palsy.

155
Q

Which facial areas are affected by lower motor neuron lesions?

A

Ipsilateral upper and lower face.

156
Q

What is the most prevalent form of color discrimination deficiency among males and females?

A

Deuteranomaly
* have all 3 photo pigments but there is a shift of maximum sensitivity of chlorolabe towards longer wavelengths
* red-green color blindness

157
Q

Optic nerve disease may cause what kind of acquired color vision deficiency?

A

Red-green

158
Q

What are optic nerve drusen?

A

Hyaline-like calcific material deposition in the optic nerve

Present in roughly 0.3% of the general population

159
Q

Are optic nerve drusen typically unilateral or bilateral?

A

Generally bilateral, but may present unilaterally

Seen almost exclusively in Caucasians

160
Q

What is thought to contribute to the condition of optic nerve drusen?

A

A genetic component

The exact inheritance mode remains unclear

161
Q

What are the symptoms of optic nerve drusen?

A

Most patients are asymptomatic; visual field defect may cause symptoms

162
Q

What clinical signs are observed in the early stages of optic nerve drusen?

A

Drusen may be located deep beneath the optic disc surface, causing elevation with clear margins

The disc will not appear hyperemic and surface vessels remain visible

163
Q

What happens to optic nerve drusen with age?

A

Drusen become more prominent and move anteriorly, exposing irregular nerve margins

The disc may appear elevated with no physiological cup

164
Q

What associated condition may occur with optic nerve drusen?

A

Associated field loss can occur

Rarely, a choroidal neovascular membrane may develop adjacent to the optic nerve

165
Q

How is a diagnosis of buried drusen best confirmed?

A

Via B-scan ultrasonography or optical coherence tomography (OCT)

Turning down the gain while performing B-scan ultrasonography allows for visualization of the drusen

166
Q

What characteristic do drusen exhibit during ultrasonography?

A

Possess high acoustic reflectivity

Drusen will autofluoresce

167
Q

Is treatment typically required for optic nerve drusen?

A

No, treatment is typically not required

168
Q

What are optic nerve drusen?

A

Optic nerve drusen are calcified deposits that form on the optic nerve head.

169
Q

What condition may patients with optic nerve drusen experience in addition to drusen?

A

Patients may experience elevated intraocular pressure.

170
Q

Why may treatment be required for patients with both optic nerve drusen and elevated intraocular pressure?

A

Field loss may be due to the elevated intraocular pressure rather than the drusen.

171
Q

What challenge arises when both elevated intraocular pressure and optic nerve drusen are present?

A

It is difficult to attribute field loss to either elevated intraocular pressure or drusen.

172
Q

What is typically observed in discs with drusen in terms of cupping?

A

Discs with drusen will typically not develop cupping.

173
Q

What type of damage is associated with cupping in the optic nerve?

A

Cupping is observed with glaucomatous damage.

174
Q

What are the typical causes of Visual Pathway Lesions?

A

Vascular disorders or tumors

175
Q

As the lesion moves posteriorly in the visual pathway, how do the visual field defects change?

A

They become more homonymous and congruent

176
Q

What visual field defect is typically caused by a Pituitary Gland Tumor?

A

Bitemporal Hemianopsia

177
Q

In a Junctional Scotoma, where is the lesion located in relation to the visual field defect?

A

Ipsilateral to the central visual field defect; superior temporal quadrant defect on the contralateral side

178
Q

What mnemonic can be used to remember the visual field defect locations caused by Parietal and Temporal lobe lesions?

A

PITS

179
Q

What visual field defect is caused by a Parietal lobe lesion?

A

Inferior quadrantanopia

180
Q

What visual field defect is caused by a Temporal lobe lesion?

A

Superior quadrantanopia

181
Q

What typically causes a Contralateral Homonymous Hemianopia?

A

Stroke or tumor

182
Q

What type of stroke is commonly associated with Contralateral Homonymous Hemianopia?

A

Posterior Cerebral Artery Occlusion

183
Q

What phenomenon often occurs with Contralateral Homonymous Hemianopia due to dual blood supply?

A

Macular sparing

184
Q

What happens to macular sparing if a tumor compresses both sides of the Posterior Cerebral Artery?

A

There will be no macular sparing

185
Q

What is the onset of symptoms for visual field loss caused by a tumor?

A

Gradual

186
Q

What is the onset of symptoms for visual field loss caused by a stroke?

A

Acute

187
Q

What should be checked first in the treatment/management of visual pathway lesions?

A

Visual fields

188
Q

What type of medical specialists should patients be referred to for further evaluation?

A

PCP or neurologist

189
Q

How do Acute Cranial Nerve Palsies present on MRI?

A

Evidence of acute trauma

190
Q

What is a characteristic feature of Chronic Cranial Nerve Palsies?

A

Spread of comitance identified with cover test in 9 positions of gaze

191
Q

What is Warfarin commonly used for?

A

Oral anticoagulant

192
Q

What does Warfarin inhibit?

A

Activation of clotting factors that depend on vitamin K for synthesis

193
Q

What process does Heparin inhibit?

A

Conversion of prothrombin to thrombin

194
Q

What is the mechanism of action of Aspirin in relation to platelets?

A

Irreversible inhibition of platelet cyclooxygenase

195
Q

Symptoms associated with lesions in Wernicke’s and Broca’s areas

A

Wernicke’s = wordy speech
Broca’s = broken speech (aphasia)

196
Q

What VF defect is caused by lesion at the temporal lobe?

A

Contralateral upper quadrantanopia
* pie in the sky

197
Q

Contralateral homonymous hemianopia with macular sparing has a lesion in which part of the visual pathway?

A

Primary visual cortex of the occipital lobe
* caused from stoke
* macular sparing because has dual blood supply (posterior and middle cerebral arteries)

198
Q

Pre-chiasmal lesion leads to what VF defect?

A

Total blindness of ipsilateral eye

199
Q

Compression of Willenbran’s knee leads to what VF defect?

A

Junctional scotoma

200
Q

What is Cortical Blindness?

A

Sudden, bilateral, complete blindness due to extensive damage to the occipital lobe.

201
Q

What are the possible causes of Cortical Blindness?

A

Congenital, cerebrovascular accident (stroke with bilateral cerebral artery blockage), cardiac surgery.

202
Q

What symptoms do patients with Cortical Blindness typically report?

A

Complete, sudden, bilateral blindness with possible visual hallucinations.

203
Q

What is Anton’s Syndrome?

A

A condition where patients deny vision loss despite being blind.

204
Q

What findings are expected during an eye exam for Cortical Blindness?

A

Normal eye exam aside from bilateral no light perception.

205
Q

What is the pupillary light reflex in patients with Cortical Blindness?

A

Present, because the occipital lobe is not responsible for the pupillary response.

206
Q

What is the Riddoch phenomenon?

A

The ability to perceive moving but not stationary objects.

207
Q

What is blindsight?

A

The ability to navigate around objects despite being blind.

208
Q

Is there a treatment available for Cortical Blindness?

A

No treatment is available; loss of vision is usually permanent.

209
Q

What is Vertebrobasilar Insufficiency?

A

Occurs when the Vertebrobasilar arterial blood supply to the brain becomes blocked.

210
Q

What can cause Vertebrobasilar Insufficiency?

A

Thrombus, emboli, hypertension, or anything causing a hypercoagulable state.

211
Q

What are common symptoms of Vertebrobasilar Insufficiency?

A

Flashes of light (photopsia), bilateral transient visual loss (amaurosis fugax), diplopia, nystagmus.

212
Q

What systemic symptoms are associated with Vertebrobasilar Insufficiency?

A

Vertigo, unilateral weakness and sensory loss, history of syncope (drop attacks).

213
Q

What signs might be present in a patient with Vertebrobasilar Insufficiency?

A

Homonymous visual field defects.

214
Q

What is the treatment focus for Vertebrobasilar Insufficiency?

A

Controlling the hypercoagulable state with prophylactic use of daily aspirin.

215
Q

What is Cortical Blindness?

A

Sudden, bilateral, complete blindness due to extensive damage to the occipital lobe.

216
Q

What are the possible causes of Cortical Blindness?

A

Congenital, cerebrovascular accident (stroke with bilateral cerebral artery blockage), cardiac surgery.

217
Q

What symptoms do patients with Cortical Blindness typically report?

A

Complete, sudden, bilateral blindness with possible visual hallucinations.

218
Q

What is Anton’s Syndrome?

A

A condition where patients deny vision loss despite being blind.

219
Q

What findings are expected during an eye exam for Cortical Blindness?

A

Normal eye exam aside from bilateral no light perception.

220
Q

What is the status of the pupillary light reflex in patients with Cortical Blindness?

A

Present, because the occipital lobe is not responsible for the pupillary response.

221
Q

What is the Riddoch phenomenon?

A

The ability to perceive moving but not stationary objects.

222
Q

What is blindsight?

A

The ability to navigate around objects despite being blind.

223
Q

Is there a treatment available for Cortical Blindness?

A

No treatment is available; loss of vision is usually permanent.

224
Q

What is Vertebrobasilar Insufficiency?

A

Occurs when the Vertebrobasilar arterial blood supply to the brain becomes blocked.

225
Q

What can cause Vertebrobasilar Insufficiency?

A

Thrombus, emboli, hypertension, or anything causing a hypercoagulable state.

226
Q

What are common symptoms of Vertebrobasilar Insufficiency?

A

Flashes of light (photopsia), bilateral transient visual loss (amaurosis fugax), diplopia, nystagmus.

227
Q

What systemic symptoms are associated with Vertebrobasilar Insufficiency?

A

Vertigo, unilateral weakness and sensory loss, history of syncope (drop attacks).

228
Q

What signs might be present in a patient with Vertebrobasilar Insufficiency?

A

Homonymous visual field defects.

229
Q

What is the treatment focus for Vertebrobasilar Insufficiency?

A

Controlling the hypercoagulable state with prophylactic use of daily aspirin.

230
Q

What is idiopathic intracranial hypertension also known as?

A

Pseudotumor cerebri

231
Q

What causes papilledema in idiopathic intracranial hypertension?

A

Elevated intracranial pressure in the absence of an intracranial space-occupying lesion

232
Q

In which demographic is idiopathic intracranial hypertension most commonly observed?

A

Females of child-bearing age who are overweight

233
Q

Name a medication associated with idiopathic intracranial hypertension.

A

Tetracyclines, naladixic acid, oral contraceptives, steroids, vitamin A, isotretinoin, growth hormones, sulfa drugs, tamoxifen, thyroid replacement therapy, phenytoin

234
Q

Fill in the blank: Idiopathic intracranial hypertension is characterized by _______.

A

Papilledema caused by elevated intracranial pressure

235
Q

True or False: Idiopathic intracranial hypertension can occur with enlargement of the ventricles due to hydrocephalus.

A

False

236
Q

What is the chance of developing maculopathy in patients with non-central optic pits?

A

Up to 45%

This statistic highlights the significant risk associated with non-central optic pits.

237
Q

What are the two main suggested origins of subretinal fluid in optic pits?

A
  • Subarachnoid space
  • Vitreous

This indicates ongoing debate and research regarding the source of the fluid.

238
Q

What has been observed in eyes with retinal detachment related to optic pits?

A

A small opening in the membrane covering the pit

This finding suggests a structural change associated with retinal detachments.

239
Q

What anatomical feature might contribute to retinal detachment in cases of optic pits?

A

Atypical Cloquet’s canal traction

This indicates a potential mechanical factor in detachment formation.

240
Q

Which types of optic pits are more at risk for developing detachments?

A
  • Temporally located pits
  • Larger pits

This suggests that location and size are important risk factors.

241
Q

What is the success rate of laser treatment applied to the peripapillary area for reduced visual acuity?

A

Approximately 30%

This low success rate indicates the challenges in treating maculopathy associated with optic pits.

242
Q

What are alternative treatment options for patients with optic pits experiencing maculopathy?

A
  • Pars-plana vitrectomy
  • Injection of gas tamponade without vitrectomy

These options reflect the limited approaches available for management.

243
Q

What is the prognosis for maculopathy associated with optic pits?

A

Poor prognosis

This emphasizes the seriousness of the condition and its complications.

244
Q

What should patients be given to monitor changes in their vision associated with optic pits?

A

An Amsler grid

This tool helps in detecting vision changes that may indicate complications.

245
Q

Ocular complications of optic pit

A

Serious macular detachment
* maculopathy associated with optic put does not have good prognosis
* patient should be given amsler and RTC ASAP if changes

246
Q

What type of migraine has visual aura followed by a headache

A

Classic migraine
* zig zag light that grows larger with time
*aura lasts for 20 minutes
*then followed by headache with nausea and light sensitivity

247
Q

Common migraine

A
  • last several hours to days
  • nausea/vomitting
  • photophobia
    *no visual aura preceeding headache
248
Q

What is an ocular migraine?

A

A type of migraine characterized by visual disturbances, such as flashing lights, zigzag patterns, or temporary loss of vision, usually in one eye.

249
Q

How long do the symptoms of an ocular migraine typically last?

A

About 20 to 30 minutes.

250
Q

Do ocular migraines always occur with a headache?

A

No, they can occur with or without a headache.

251
Q

What is the understood cause of ocular migraines?

A

The exact cause isn’t fully understood, but it is thought to be related to changes in blood flow in the eye or brain.

252
Q

Fill in the blank: Ocular migraine is characterized by _______.

A

visual disturbances.

253
Q

True or False: Ocular migraines can affect both eyes.

A

False.

254
Q

Leber hereditary optic neuropathy signs on fundus photos

A

Optic nerve head pallor, both eyes
*genetic testing for dx, mutation in maternal mitochondrial DNA
* M>F

255
Q

Pseudotumor cerebri symptoms

A

Symptoms: blurry vision, headache, nausea, color vision abnormalities (dyschromatopsia), transient vision disturbances, and reduced affect

256
Q

Idiopathic intracranial hypertension signs

A
  1. Papilledema (increased ICP)
  2. Normal brain MRI/CT
  3. High cerebral spinal fluid on lumbar puncture (>250 mmH2O for obese patients)

IIH mostly seen in young, fertile and fat females

*CSF for non-obese patients >200mmH2O

257
Q

Tx for pseudotumor cerebri?

A
  1. Discontinue associated medications (ex: birth control, Accutane)
  2. Lose weight
  3. Oral acetazolamide (Diamox 1000mg po QD)
258
Q

With OIS, the carotid artery is blocked by ___%

A

90% blocked

NBEO Part 2 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions