Papilledema and Pupillary Disorders (F) Flashcards
What does a Horner syndrome patient with facial anhydrosis indicate?
lesion between posterior hypothalamus and carotid bifurcation (first order)
What is the treatment for idiopathic intracranial hypertension with with severe or progressive visual loss?
- optic nerve sheath decompression
- high dose steroids and acetazolamide
- lumbo-peritoneal shunt for failed ONSD or intractable headache
What are some pharmacologic agents that can result in pupillary dilation?
- scopolamine or permethrin
- angels trumpet, jimson weed, or belladonna
- antihistamines
What is the result of an interruption between mesencephalon and sphincter?
pupillary dilation and decreased speed and amplitude of constriction (EPD)
What is the result of an interruption between retinal ganglion cells and pretectal nuclei?
APD
What are factors associated with higher risk of visual loss for patients with idiopathic intracranial hypertension?
- systemic hypertension
- anemia
- peripapillary subretinal neovascularization
- older age
- high myopia
What does hydroxyamphetamine help to indicate in Horner Syndrome and how?
dilation indicates first or second order lesion due to cause of NE release from normal post-ganglionic neuron
What are possible etiologies of Horner syndrome second order neuron lesions?
- chest lesions (occult carcinoma of lung apex, mediastinal mass)
- neck lesions (trauma, abscess, thyroid neoplasm, internal carotid dissection, lymphadenopathy)
- surgery (thyroidectomy, radical neck surgery, carotid angiography
What is the treatment for idiopathic intracranial hypertension with no vision loss?
- symptomatic headache therapy
- weight reduction
- acetazolamide
What is an increase in intracranial pressure with one swollen disc and one atrophic disc called?
Foster Kennedy Syndrome
What does phenylephrine help to indicate in Horner Syndrome and how?
dilation or greater relative dilation suggests post-ganglionic lesions (third order) due to denervation hypersensitivity
Why do lesions at the LGN, optic radiations, and visual cortex not generally result in afferent pupillary defects?
afferent pupillary fibers leave the optic tract before the LGN
Where does the pre-ganglionic (second order) neuron of the oculosympathetic pathway arise? 1. Where does it synapse? 2
- ciliospinal center of Budge (under subclavian artery, over lung apex, and ascends with internal carotid)
- superior cervical ganglion (plexus on internal carotid artery)
When are headaches associated with idiopathic intracranial hypertension worse?
- mornings
2. postural changes or Valsalva maneuvers
What is the treatment for idiopathic intracranial hypertension with mild visual loss?
- acetazolamide
- furosemide
- weight reduction
What is the parasympathetic efferent pathway to the pupil?
- efferent originate at Edinger-Westphal complex
- Fibers exit the midbrain in third cranial nerve and follow inferior division in cavernous sinus to orbit
- fiber synapse at ciliary ganglion in posterior orbit, btw optic nerve and LR
- postganglionic fibers travel in short ciliary nerves to globe then btw sclera and choroid to sphincter and CB
If there is the same amount of anisocoria in the light as in the dark, what is the likely cause?
physiologic anisocoria
Where does the central (first order) neuron of the oculosympathetic pathway arise? 1. Where does it synapse? 2
- hypothalamus
2. ciliospinal center of Budge (T1-C8)
What is the pathway of the post-ganglionic (third order) neuron of the oculosympathetic pathway arise? 1. Where does it synapse? 2
- superior cervical ganglion, travel along internal carotid into cavernous sinus, then VI cranial nerve, then nasociliary nerve (V1), then the long ciliary nerve in to the orbit
- dilator muscle
