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Binocular Vision > Peads : Neuro-Opthalmology - Alistair > Flashcards

Peads : Neuro-Opthalmology - Alistair Flashcards

1
Q

What are some tips when approaching exams?

A

do ur brainscapes bitchs

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2
Q

How can we diffrentiate between retina and optic nerve signs?

A
  1. Elctrophysciology is invalable!! OCT, ERG,EOG and VEP
    There are limitaions to each tests tho
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3
Q

What is a neurofibromas?

A

firm swelling

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4
Q

What can upperlid neurofibromas suggest?

A

Px has glaucoma

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5
Q

What can the face and head abnormalities show you?

A

Some developmental issues which can lead to shallow orbits ect

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6
Q

What can ptosis imply?

A

MG

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7
Q

What are five characteristics of MG?

A
  1. Varibility, linked to fatiguness
  2. 50% will affect the eyes
  3. 12% cause restriction in the eyes, eyelids and eye muscles
  4. Affects facial and oropharyngeal (throat) muscles
  5. Women > men
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8
Q

What is the cause of myasthenia?

A

Abnormalilties of the ACH receptors

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9
Q

How can we test for MG?

A
  1. Endrophonium (tensilon)
  2. ACH receptor antibody (blood test)
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10
Q

How does edrophonium testing work for MG?

A

It is a reversible inhibitor which will increase ACH effect ; this will tell us if muscle weakness is due to MG fatgiue or not
problem is that it can be dangerous

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11
Q

What can be the cause of proptosis?

A
  1. Sinus disease
  2. Tumours
  3. Thyroid eye disease
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12
Q

What should we first ask ourselves when presented with proptosis?

A

WHat direction is it?

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13
Q

What diseases would manifest a on axial, straight proptosis?

A
  1. Thyroid disease
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14
Q

What diseases would manifest a off axial, not straight proptosis?

A
  1. Tumours in the orbit can push the eye out in any direction
  2. Sinus disease, this can also push out the eye in any direction
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15
Q

What are two indirection signs of reduced vision?

A
  1. Nystagmus
  2. Strabismus
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16
Q

How many types of nystagmus is there?

A

45 and they can be pendular or jerk

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17
Q

What is the definition of nystagmus?

A

This si the rhymic oscillation of the eyes.

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18
Q

What is the aetiology of nystagmus in child?

A
  1. Infantile nystagmus
  2. Reduced Vision in childhood
  3. tumours
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19
Q

What is the aetiology of nystagmus in adults?

A
  1. Brainstem issues : MS, vascular
  2. Cerebellar disease
  3. Vestibular disease
  4. CNS
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20
Q

EXTRA NOTE just for understadning nystagmus : what is cerebellar and vestibular disease?

A
  1. Cerebellar : coordination issues
  2. Vestibular : vertigo / dizziness
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21
Q

If a child has congential catarcts will the child have nystagmus?

A

No! Nystagmus is not present at birth

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22
Q

What are some types of nystagmus?

A
  1. Physiological
  2. Pathological
  3. Sensory defecit
  4. Neurological
  5. special types
  6. Idiopathic
  7. Infantile
23
Q

what should we think about when presented with someone with nystagmus?

A
  1. What age did it come
  2. what other symptoms is this asscioated too?
24
Q

How do we evaluate nystagmus?

A
  1. Uni or bilateral
  2. manifest or latent
  3. Type and degree. Jerk or pendular
  4. Direction, waveform, amplitude freq and intensity.
  5. CHP
25
Q

How can we find out the amplitude, freq, waveform and intensity?

A

Nystagmus electropgrpahy

26
Q

How does sensory nystagmus develop?

A

It will in the eye that has the poor vision due to lesions in the anterior Visual pathway.

27
Q

what age does sensory nystagmus develop?

A

Only 6 and under

28
Q

What is cortical visual impairment?

A

Abnormal visual response that is not caused by the eyes

29
Q

Can sensory nystagmus be seen in px with cortial VI?

A

No.

30
Q

WHat can the speed of direction tell us?

A

SLow = shit vision
faster = better va

31
Q

What is Asymmetric Nystagmus?

A

The nystagmus is diffrent in each eye.

32
Q

Why may asymmetric nystagmus present?

A
  1. Blind in one eye
  2. OM apraxia
  3. Spasmus nutans
33
Q

What is spasmus nutans?

A

This is idiopathic and will present as the child head nodding ; this is in the nystagmus lecture

Watch this video to see it:
https://www.youtube.com/watch?v=J77RgASz3yk

34
Q

What is oculomotor apraxia?

A

This is when the child finds it hard to move their eyes ; abnromal saccades. The casue is complex

I got this from this link:
https://aapos.org/glossary/oculomotor-apraxia

35
Q

What is the onset of infantile nystagmus?

A

between 6-12 months.

36
Q

How can we diagnose infantile nystagmus?

A

They have no ocular or neurological disease.

… if they did it would be a diffrent type of nystagmus

37
Q

what are the signs of infantile nystagmus?

A
  1. Uniplanar and normal Horizontal
  2. FH
38
Q

Are the signs pathognomic?

A

Pathognomic means the signs are specific to one condition

Answer is NO it is not specific

39
Q

How can we manage Nystagmus?

A
  1. Prisms
  2. CL
  3. Surgery

BUt they are not effective (they are shit)

40
Q

If a child has dipliopa how can we diffrentiate between the palsies?

A

ask where the diplopia is
dip changing in diff directions ect

41
Q

what can cause cranial nerve palsies?

A
  1. Raisied ICP
  2. Vascular
  3. Compresion
  4. Infections
  5. Trauma
42
Q

Why are certain nerves damaged?

A
  1. thin
  2. compressions
  3. kinking
43
Q

Why is the 6th nerve prone to insult?

A

Due to its pathyway, casuing it to do a right angle entering the cavernous sinous. This makes it vunerable to trauma and Raised ICP

44
Q

Why is the 4th nerve easily damaged?

A

It is long and thin and comes from the back of the brain. Vunerable to minor head injuries

45
Q

Is 3rd nerve easily damaged?

A

No, this one is the solider out of the three. It is the absolute role model of how things should be. Though and strong minded.

Takes brutal, catastrophic shannaniganic trauma to hurt this one. Or by aneurysm / tumour

46
Q

How can orbital diseases effect the eyes?

A

Trapped muscles in the orbit floor

47
Q

EXTRA: During the intial orbtial floor does the eye come forward or backwards?

A

Backwards, as there is space for the eye now the muscle is on the floor

48
Q

How can we assess the dipliopia?

A
  1. Mono or binocular
  2. direction of dip
  3. near, dist
  4. left or right
49
Q

what can causes unequal pupils - anisocoria ?

A

Eye diseases : such as uvietis (extra note: synechiae, we give cycloplegics to help this)

50
Q

what other pupil defects can we get?

A
  1. Efferent : parasympathetic (horners) or sympathetic (3rd nerve)
  2. Afferent
  3. Light-Near dissosciation
  4. Adies Tonic pupil
51
Q

WHat is light- near disscioation?

A

This is when the pupils react to ACC but not light

52
Q

what causes light - Near dissociation?

A

Common cause is diabetes. Can be due to tumour also

53
Q

How do we assess pupils?

A
  1. Get the child to look far ; so they are not accomodating
  2. Use a good light
54
Q
A

Binocular Vision (30 decks)

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