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Ocular Disease III > Optic Neuropathies I > Flashcards

Optic Neuropathies I Flashcards

1
Q

CN II is myelinated by:

A

oligodendrocytes

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2
Q

What are the four anatomical segments of the optic nerve

A
  1. intraocular - vascular insults; inflammation and infection
  2. intraorbital - muscle engorgement/tumors
  3. intracanalicular - most susceptible to trauma; fractures an sinus inflammation
  4. intracranial - pituitary and circle of willis
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3
Q

______ blood supply includes the SPCA (peripapillary choroidal vessels). anastamoses between SPCA are scant, making this a _____ area

A

Prelaminar; watershed

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4
Q

Lamina _____ is supplied by the SPCA and circle of inn haller

A

cribrosa

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5
Q

_____ branches from the CRA, branches from pial vessels

A

retrolaminar

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6
Q

Prelaminar region includes the retina and the ____

A

choroid

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7
Q

what does pallor of the optic nerve mean

A

you’ve lost your prelaminar vasculature which includes SPCA

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8
Q

what does it mean when you can’t see the cup ?

A

obliteration of the nerve

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9
Q

round white globular dots within the optic cup =

A

optic nerve head drusen

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10
Q

optociliary shunt vessels deal with dilation of pre existing _____ beds due to compromised venous return in the _____ region of the optic disc. They develop as a response to congested blood flow.

A

capillary; prelaminar

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11
Q

what is etiology of optic nerve shunts

A
  1. optic nerve sheath meningioma
  2. CRVO
  3. Chronic glaucoma
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12
Q

ON dysfunction includes:

A
  1. VA loss
  2. RAPD
  3. dyschromatopsia
  4. VF defect
  5. reduced CS
  6. +/- normal optic disc appearance
  7. Abnormal VEP
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13
Q

ON disease can include:

A
  1. Glaucoma
  2. Ischemic
  3. Inflammatory
  4. Infectious
  5. Demylinating
  6. Hereditary
  7. Toxic/metabolic
  8. Compressive
  9. Traumatic
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14
Q

optic neuritis is inflammation of the optic nerve. There are two types: typical and atypical.

A

Typical: due to demyelinating lesion; autoimmune disease that causes antibodies to attack the myelin sheath

Atypical: systemic infectious/inflammatory causes

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15
Q

Describe characteristics of typical optic neuritis

A
  1. sudden VA loss - progresses for a week and then improves by a month
  2. Pain on EOMs
  3. +/- RAPD
  4. Dyschromatopsia and reduced CS is usually worse than VA
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16
Q

What is a typical presentation of optic neuritis

A
  1. unilateral
  2. retrobulbar
  3. age: 15-50 but avg age is 30
  4. mostly female
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17
Q

optic neuritis also presents with _____ deficits

A

VF

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18
Q

associated symptoms of optic neuritis may include _____ of hands, problems with bladder control, ______ phenomenon, which includes altered perception of moving objects. Lhermitte’s sign as well as Uthoff sign is also prevent.

A

numbness; pulfrich

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19
Q

what is lehrmittes sign

A

flexion of head causes unpleasant electric shock like discharge originating from neck and spreading down the spine

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20
Q

what is uthoff sign

A

worsening of neurologic symptoms with increased body temperature

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21
Q

what were the 3 treatment arms of ON

A
  1. IV methylprednisolone 250 mg QID x 3 days, followed by oral prednisolone 1 mg x 11 days
  2. Oral prednisolone 1 mg x 14 days
  3. Oral placebo x 14 days
22
Q

In the study, oral steroid alone, _______rate of recurrence optic neuritis

A

increased

23
Q

IV steroids reduced risk for development of MS after initial attack of ON for ____ years, no benefit after that. Brain MRI is extremely useful in identifying patients who are at a higher risk for dev MS

A

2

24
Q

15 year overall risk in MS after ON is ____ in women.

A

75%

25
Q

Initial MRI is the most _____ risk factor in developing MS. 0 lesions = _____%, 1 lesion = ______%, 3+ lesions = _____%

A

predictive; 25; 60; 78

26
Q

what are other risk factors for MS

A
  1. white race
  2. family history of MS
  3. ill defined neurologic complaints
  4. previous episode of acute optic neuritis
27
Q

what are low risk for MS?

A
  1. severe disc swelling
  2. no pain
  3. disc or PPA hemorrhage
  4. retinal exudates (infection)
  5. NLP vision
  6. Male sex
28
Q

Dissemination in ____ means you have two separate events

A

time; new lesion when compared to previous scan irrespective of timing. also includes simultaneous prescene of enhancing and non enhancing T2 lesion on any one scan

29
Q

Dissemination in _____. It includes greater than or equal to 1 enhancing_____lesion in greater than or equal to 2 locations.

A

space; look at multiple sections. different lesions in different parts of brain. Usually enhancing T2 lesion in 1+ locations.

T2

30
Q

_____ lesion is active and will light up. _____ lesion is an old lesion

A

T2, T1

31
Q

lesions usually occur around the _____

A

ventricles

32
Q

Pts in the CHAMPS study who had a demyelinating event AND an abnormal MRI had a 44% reduced rate of developing MS by taking _____ injection

A

avonex

33
Q

_____ therapy is given to those high risk patients who have 1+ MRI lesions

A

Interferon

34
Q

T/F, After diagnosing optic neuritis, you should order an MRI and refer to neurology for treatment initiation

A

true

35
Q

______ bands, aka immunoglobulins are inflammation related proteins in blood serum and CSF. While present in CSF, it indicates inflammation of the CNS

A

oligoclonal; 80-90% of pts with MS have permanently observable oligoclonal bands

36
Q

_____ is the first oral treatment for MS, but it can cause macular edema

A

gilenya

37
Q

What are the different ways to treat MS

A
  1. Intramuscular
  2. IV
  3. Oral
38
Q

______optic neuritis includes falling out of typical age range. They’re either less than 18 or greater than 50 yo. It will usually present ______, and won’t be painful. It will present with anterior/posterior ______, as well as retinal exudates, and hemorrhages. Severe optic nerve swelling. VA continues to worsen past 1 week. Recurrence within short interval or during steroid taper

A

Atypical; bilateral; uveitis

39
Q

What do you have to do after you diagnosed your patient with atypical optic neuritis

A
  1. Bloodwork:
    - CBC with differential: RBC, WBC, platelet levels, hemoglobin, and hematocrit
  • ESR and CRP: inflammation
  • ACE (sarcoid)
  • RPR- VDRL, RTA-Abs (syphillis)
  • ANA (looks for lupus)
  • Lyme titers
  • Chest xray
    2. MRI
    3. Lumbar puncture
40
Q

T/F Other causes of optic neuritis include CT disease, infectious, or infiltrative

A

true

41
Q

what are ex of CT disease

A
  1. lupus
  2. sjogrens
  3. bechets
42
Q

what are ex of infectious disease

A
  1. viral: measles, mumps, HZV
  2. bacterial: lyme, syphillis
  3. parasitic: toxoplamsa, toxocariasis
43
Q

what are ex of infiltrative

A
  1. sarcoidosis

2. cancer: lymphoma, leukemia

44
Q

neuromyelitis optica can present as _____ disease which presents as acute optic neuritis and transverse myelitis which is inflammation of the spinal cord that causes weakening of the limbs

A

devic

45
Q

Two diagnostic criteria of neuromyeltis optica requires 2 _____ and 2 ______

A

absolute; supportive

46
Q

absolute includes optic neuritis and acute myletis. Supportive includes contagious spinal cord lesion greater than or equal to 3 vertebral segments on MRI, brain MRI not meeting diagnostic criteria for MS, and positive _____ IgG serology

A

NMO

47
Q

what do the NMO antibodies target ?

A

aquaporin 4; nervous system’s main water channel protein. Inflammatory demyelination results in necrotic damage of white and grey matter…astrocyte damage, demylinationn, neuronal loss, and necrosis

48
Q

NMO can affect children but median age of onset is _____. its relapsing or monophonic. Treatment is via ______ therapy which includes IV steroid, azathioprine, rituximab

A

39; immunosuppresive

49
Q

NMO can cause _____ failure, which is not seen in MS. MRI brain lesions are normal/nonspecfic in NMO, CSF oligoclonal bands usually absent in NMO

A

respiratory

50
Q

T/F NMO has higher incidence in asians and aa, carries poor prognosis with higher incidence of permanent paralysis, binocular blindness, and respiratory failure. rehab is similar to patients with spinal cord injuries

A

true

51
Q

_____ myelitis is another inflammatory CNS condition that deals with focal inflammatory disorder of spinal cord ,and presents with numbness and paresthesias and may progress to MS. eyes are usually not involved but can progress to optic neuritis later

A

transerve

52
Q

Acute disseminated encephalomyelitis (ADEM) is usually seen in children after viral injections or immunizations. pts will get fever, nausea, vomiting, positional vertigo. Treatment includes:

A
  1. high dose IV steroids for 3-5 days

2. oral taper for 4-6 weeks

Ocular Disease III (16 decks)

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